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VOLUME 70 No.2 MARCH 2013

STRONG SUPPORT FOR PHS CLAIM Print Post Approved: PP241437/00033

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CONTACTS NSW Nurses and Midwives’ Association For all membership enquiries and assistance, including Lamp subscriptions and change of address, contact our Sydney office.

VOLUME 70 No.2 MARCH 2013

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


12 | Strong support for PHS claim Members have endorsed the NSWNMA Public Health System (PHS) draft claim that aims to deliver a 2.5% pay rise and the extension of ratios into new specialty areas, as well as improvements in some hospitals. Helen Wilmore

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14 | Time to care The Association’s community health campaign aims to match the growing demand for more health care at home with more time for community nurses to deliver that care.

Editorial Committee • Brett Holmes, NSWNMA General Secretary • Judith Kiejda, NSWNMA Assistant General Secretary • Coral Levett, NSWNMA President • Roz Norman, Tamworth Base Hospital • Elsie May Henson, Barraba Multi Purpose Service • Peg Hibbert, Hornsby & Ku-Ring-Gai Hospital • Michelle Cashman, Long Jetty Continuing Care • Richard Noort, Justice Health Advertising Patricia Purcell T 8595 2139 or 0416 259 845 or F 9662 1414 E Records and Information Centre – Library To find old articles in The Lamp, or to borrow from the NSWNMA nursing and health collection, contact: Jeannette Bromfield, RIC Coordinator T 8595 2175 E


The Lamp ISSN: 0047-3936

24 | Alarm over coal dust

21 | Visit your MP to gain support for ratios NSWNMA members have begun visiting their local MP to explain the need to extend and improve nurse-patient ratios in New South Wales.


30 | Getting involved to tackle Sydney issues


28 | No reform without nurses

Federal health minister Tanya Plibersek says nurses are critical to the success of health care reform.

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 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 2013 Free to all Association members. Professional members can subscribe to the magazine at a reduced rate of $50. Individuals $78, Institutions $130, Overseas $140. THE LAMP MARCH 2013 | 3


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Let’s take our campaign wider Voting has now closed on our 2013 Public Health System log of claims with a comprehensive vote in favour of the recommended claim (see page 12).

It is vital we convince politicians of the merit of our campaign. It is crucial that they hear the perspective of nurses: our view of what is happening in our public health system and what is needed to improve it.

This marks the end of the initial stage of our campaign to improve and extend ratios in the public health system and signals the beginning of the next stage. We will present the claim to the state government in the near future allowing plenty of time for negotiations to take place before the current award expires on 30 June. Our big challenge now is to convince the government and the public of the merits of our claim. We know from long experience that improvements to public health and to nurses and midwives’ pay and conditions will not be given to us on a plate. They will come because we are organized and determined and prepared to act and after we have done the hard work to win the support of the public. The Association has already started a TV campaign to educate the public about our issues and to try and win their support for our campaign for more nurses. We need to continue this approach of educating and convincing people of the need for more nurses on all fronts including with NSW Members of Parliament. WE NEED TO CONVINCE THE POLITICIANS It is vital we get our message through to the politicians. We can’t assume that they understand all the issues involved in the health sector. Ultimately they are the decision makers who make the final call. It is vital we convince them of the merit of our campaign. It is crucial that they hear the perspective of nurses: our view of what is happening in our public health system and what is needed to improve it. Our experience and our research tell us that nurses have a very credible voice on issues of health. We are correctly perceived as being at the frontline, that we understand the issues and we have a credible track record as honest advocates for improvements that will benefit our patients. Recent media attacks on adverse events and undesirable outcomes remind us however that nurses and midwives’ positive public profile is not sacrosanct. If care ever falls below expected

standards we can expect close scrutiny by the public and the media. We need to bear this in mind in all we do as professionals and as a union. In this issue of the Lamp (see pages 18-19) we profile some branches who have already visited their local MP to argue our case and enlist their support. Obviously many backbenchers will not want to deviate from their party line. We need to remind them that their first responsibility is to their electorates and that we expect them to go back to their party rooms and advocate for the patients of their electorate. This is how politics should be determined – not by dictat from the Treasury. If you haven’t already done so I would urge all NSWNMA branches to organize delegations to visit your local MP and argue your case for more nurses. THERE IS PLENTY OF EVIDENCE TO SUPPORT OUR CASE The arguments we can present to MPs are not emotional and self-serving. They are grounded in fact and underpinned and supported by a vast and growing body of research. More and more studies, taken from a wide variety of international settings, using large, statistically significant samples are coming to similar conclusions: that there is a strong link between higher nurse staffing and higher RN to patient ratios and lower hospital-related mortality and safer patient outcomes (see pages 22-23). In our last public health system campaign we achieved great things but the job isn’t finished. Many hospitals and nursing specialties achieved significant improvements. We now all need to stand together to see these improvements extended into new areas that need them just as urgently. More community nurses will reduce the pressure on public hospitals. More ED nurses will improve patient flow from the source. More country nurses will make rural health more sustainable. The public health system is so interconnected and interdependent that we will all benefit from extensions and improvements to ratios in these areas. THE LAMP MARCH 2013 | 5



Blame those who pull the purse strings I read an article about NHS nursing staff – the emphasis was that nursing staff are less caring and compassionate in today’s role and nursing has lost its nurturing, professional status. As a nurse of 29 years in one capacity or another, and as a former recipient of NHS health delivery, it is simple: nurses are not less caring, certainly not less hardworking. They are simply stretched to capacity with unreasonable workloads and administrative tasks. It is surely not the intention of any nurse to appear uncaring, unfeeling or unprofessional. It is a health service that wants more but delivers less in terms of staff ratios, pay and working conditions. Until ratios are established and implemented, the reputation of this noble profession will continue to be tarnished and criticised. Until then what choice do staff members have but to carry on in conditions that are unsafe for both patients and staff? Put an end to the blame culture that is directed at staff and direct it to the individuals pulling the strings of the purses. Deborah Soper, EN

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Community Nursing I think community nurses are so important: first time mothers need so much support as every baby is different and mothers and fathers need to feel confident and have as much knowledge and support as possible to be able to meet the needs of their new baby, as well as being able to enjoy being new parents. Rushing and driving around between home visits can sometimes cause problems for community nurses and that’s why ratios will ensure safety for nurses and will in turn ensure that mothers and other patients have optimal care. Mimi Chu, RN NSWNMA responds The NSW Nurses and Midwives’ Association understands that our ageing population and the increasing prevalence of chronic and complex medical conditions pose significant challenges for the public health system. More community nurses means more face-to-face time with patients, which could ultimately relieve the Public Health System. In our current Award campaign for the public health system we are seeking an equivalent ratios system for community nurses that equates to more face-to-face time with patients and the ability to provide safer care.

New grads crying out for jobs I am one of the many RNs who graduated last year and I finally have my long-awaited RN registration. I have been looking for almost three months for RN positions. I’ve been to several hospitals in person and the question is always the same: have you got post-graduation experience? My answer is “no”. How can I have experience if no-one is giving me the opportunity? I missed out on getting into the New Grad Program and many missed out, because of a recent graduate backlog. It is very frustrating. I am not the only one in this awful situation, there are many thousands. I already participated in your action program and sent many emails about this to MPs. Some have answered but with no mention of whether the New South Wales government will do something about the law of having one-year post-grad experience. I am very happy to take part in any action that you plan to get results. Birsen Koc, RN NSWNMA responds The Australian Nursing Federation, along with state branches like the NSWNMA, launched a campaign last year called “Stop Passing The Buck” to address this very issue. We are aware that new nursing graduates are not being offered jobs. In Tasmania, only 30% of nurse graduates have been employed, in Queensland only 10%, in South Australia 50% and there are 800 nurse graduates without employment in Victoria.This is a problem nationally. To find out more about the campaign go to


Talk to your local MP The Tamworth Base Hospital Branch of the NSWNMA recently set up a campaign committee to help support the Association through imminent award negotiations with the current state government. We have members from across the facility who have agreed to take on additional roles such as media liaison, community liaison, activity coordinators and resource (signs, posters etc) support, as well as general support to the Branch Executive. As a first step in our campaign in support of the log of claims our media liaison committee member set up a meeting with the local State Member of Parliament, Mr Kevin Anderson (National Party). This meeting gave us the opportunity to outline to the local member the reasons why ratios are so important in regional and rural areas, and to give examples of the many difficulties nurses from these facilities encounter. It was pointed out that it is not unusual for a Registered Nurse in a small rural facility to have the care of up to 20 patients with one Enrolled Nurse to assist. The RN would also be responsible for the management of the Emergency Department. In larger hospitals, like Tamworth, ratios are starting to make a difference in medical and surgical wards. The difficulties in encouraging experienced Registered Nurses to work in rural and regional facilities was also discussed. Mr Anderson gave a commitment to discuss the difficulties nurses face in his electorate whenever he had an opportunity, and offered his support. He was very surprised to learn that more than 550 nurses were members of the Association at Tamworth Base and that most of the other facilities in his electorate had very high union membership also. It is important that Association members make the effort to visit their local member of parliament and ensure he or she is aware of the current Log of Claims and why nurses need ratios. The creation of this link to your local member is important and several visits over time are anticipated. Like many members of the public, politicians are not always aware of the workload encountered by our community nurses, mental health nurses or nurses in specialty areas such as paediatrics, or the factors that impede nurses in their work. It is important we are the ones to tell them, drawing on our experience as clinicians. I encourage all Branches to set up a campaign committee as soon as possible and organise one or more member visits with their local member, as a priority. Rozlyn Norman, Paediatrics, Tamworth Rural Referral Hospital



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Irish boycott bites

Under the scheme the Irish health service, the Health Service Executive (HSE), proposed to hire 1000 nurses graduating in 2012 on a rate of pay 20% lower than was previously available. Britain

Cameron targets nurse pay British Prime Minister David Cameron wants to tie nurses’ pay to how well they look after their patients.

to improve patients’ In an incredible experience of the reaction to a damning service. report on failings at the Mid Staffordshire “There are some hospital, Cameron simple but profound pledged a shakeup of things that need to nurses’ salaries as happen. Nurses one of a number of should be hired and moves he said needed promoted on the basis to be made without of having compassion delay. as a vocation and not just academic According to the qualifications,” Guardian newspaper, Cameron said. Cameron identified “We need a style of the National Health leadership from Service’s (NHS) nurses which means 300,000 nurses as poor practice is not the key group of tolerated and is driven health professionals


off the wards. Another issue is whether pay should be linked to quality of care rather than just time served at a hospital. I favour this approach,” he added. Cameron also signalled strong support for the recommendation that doctors, nurses, hospital managers and board directors should face criminal charges if they are responsible for failings in care. Other

A boycott called by Irish nursing unions, of a controversial graduate nurse recruitment scheme, seems to be working. Under the scheme the Irish health service, the Health Service Executive (HSE), proposed to hire 1000 nurses graduating in 2012 on a rate of pay 20% lower than was previously available. In addition the nurses would be hired on two-year contracts instead of permanent contracts. The Irish national broadcaster, RTE, described the rate of applications for the jobs as “paltry” and the closing date for applications has been extended. The HSE has said that the 1000 posts would not be additional positions, but would replace overtime and the use of agency nurses. Irish Nurses and Midwives’ Organisation general secretary, Liam Doran, told RTE that the fact the scheme was being extended proved it was not an education-driven programme, but a cut price jobs initiative for nurses.

recommendations that came out of the report included: • Regulation of the NHS’s 800,000 healthcare assistants. • NHS managers and bosses to join a registration scheme and face disqualification if they fail to deliver good care. • A legal “duty of candour” compelling NHS staff to admit to mistakes.

United States

Ratios lead to lower re-admissions


A study published in the American journal Medical Care has found that increased nurse-to-patient ratios and good work environments for nurses are linked to lower, 30-day readmission rates for patients suffering from heart failure, myocardial infarction and pneumonia. The research team at the Pennsylvania School of Nursing analysed data from a cross-sectional survey of registered nurses in California, New Jersey and Pennsylvania, about hospital work environment, nurse staffing levels and educational attainment, as well as data from the American Hospital Association Annual Survey. Study leader Professor Matthew McHugh said that, even after accounting for patient and hospital characteristics, nurse staffing levels and the nurse work environment had a significant effect on patient care. “If it’s a good place for a nurse to work, he or she is able to do the things that help prevent readmissions. It’s important to have good relationships with colleagues and physicians, and support by managers. This is one thing hospitals know they can do to keep patients out of the hospital. Regardless of what the outcome is, patients are better off in hospitals where nurses are happier doing their job,� he said. According to the study, each additional patient-per-nurse in an average nurse’s workload was associated with 7%, 6% and 9% higher odds of readmission within 30 days of being discharged, for heart failure patients, pneumonia patients and myocardial infarction patients, respectively.

Nursing home accused of hiring prostitutes An English nursing home has been accused of hiring sex workers who, according to the Times newspaper, meet residents in a special room and place a “special red sock� on the door for privacy. Caregivers are said to check on the rooms every 15 minutes, the paper reported. The Chaseley nursing home caters mostly to ex-soldiers. A former Chaseley manager, Helena Barrow, told The Sun nespaper that professionals offer a service that is both therapeutic to residents “frustrated� by “primeval needs� and helpful for the staff. “If you have a resident who is groping staff, one way of resolving that problem is to get a sex worker in who is trained to deal with that situation,� she said. “The fact is sex workers are allowed by law to sexually enable people but care workers are not.� The American online magazine, Slate, discussed sexual activity and sexual expression in nursing homes as part of its 2007 “sex issue�, reporting that a survey had found that about a quarter of Americans aged between 75 and 85 were having sex.

Enrolled Nurse State Conference 2013 NURSING & MIDWIFERY SCHOLARSHIPS Opens 4 March Marrcch 2013 – Closes 19 April 2013

> Continuing Professional Development

The Enrolled Nurse Professional Association NSW are pleased to invite you to the 20th Enrolled Nurse state conference being held in Sydney at the Mercure Hotel. The conference is organized by ENPA enabling delegates to discuss and disseminate information to other nurses, forge friendships and networking with colleagues.


WHEN & WHERE Apply online www freecall 1800 117 262

19-20 September, 08.00–09.00am for registration Mercure Hotel, 818–820 George Street, Sydney Members $310 for both days. Non Members $340. REGISTRATIONS CLOSE - Friday 6 September

ENQUIRIES & REGISTRATION An Australian Government initiative supporting nurses and midwives. ACN, Australia’s professional organisation for all nurses is proud to work with the Department of Health and Ageing as the fund administrator of this program.

Please direct all enquiries and registrations to: Enrolled Nurse Professional Association PO Box 775 , Kingswood NSW 2747 , Tel: 1300 554 249 Rebecca – Employers requiring an invoice contact Roz –





ANF says health must be top election priority

More support for Bahrain’s nurses

The Australian Nursing Federation has called on all sides of politics to ensure that health is a top priority at the upcoming federal election.

Australian nurses are backing an international campaign for the release of seven health workers imprisoned in the Persian Gulf kingdom of Bahrain. The seven – three nurses, two surgeons, a pharmacist and an ophthalmologist – are behind bars and subject to torture because they treated protesters injured during the military crackdown on Bahrain’s pro-democracy movement. The Australian Nursing Federation has launched a solidarity campaign with Bahrain’s health workers. The ANF says health services have been taken over by the military and more than 90 medical staff, including nurses, have been targeted for treating injured protesters. “We are appalled that nurses and other healthcare professionals in Bahrain continue to be locked-up simply for doing their job – caring for the sick and injured,” said ANF Federal Secretary, Lee Thomas. Within a week of the ANF launching its campaign in February, nurses from around Australia had sent 211 messages of support to the seven imprisoned medics. The ANF campaign is backed by the ACTU and the Australian Greens who pledged to move a motion in the Senate urging federal parliament to get behind the pro-democracy movement in Bahrain and call for the release of political prisoners. The seven jailed medics include the Secretary-General of the Bahrain Nursing Society, Ibrahim al Demistani, who faces a three-year jail sentence. His colleague Rula Al’Saffar, President of the Bahrain Nursing Society, was to have presented a seminar at the NSW Nurses and Midwives’ Association in Sydney in February, but was unable to get a visa in time. She plans to visit Australia later this year. Rula was jailed and tortured by the Bahrain government after treating protestors in 2011. Since being acquitted in June 2012, Rula has been travelling the world campaigning for the release of her colleagues and to raise awareness about the ongoing challenges for health professionals in Bahrain.

“The ANF will be seeking urgent representations with all major parties as well as key independents to put our health platform to them and asking that they commit to the ongoing delivery of safe patient healthcare for the Australian community,” ANF Federal Secretary Lee Thomas said. Ms Thomas said the significant issues that must be addressed as part of the ANF’s health platform include: • The predicted shortage of 109,000 nurses and midwives by 2025. In the aged care sector alone, there is currently a shortage of 20,000 nurses. • The continued underemployment of Australia’s nursing graduates. • Removing HECS fees as an incentive for nursing graduates in under-resourced and short-staffed areas such as rural and remote communities. • Experienced nurses and midwives losing their jobs due to “slash and burn” health budget cuts across the states and territories. • Providing the right staffing levels for nurses and midwives to ensure the delivery of safe patient care.

To send a message to Bahraini nurses still in jail, go to:

CPD courses within NSW > Immunisation update | 5 April | Burwood NSW | RN | Half day > Wound management | 2 – 3 April | Alstonville NSW | RN, EN > Infection prevention update | 11 – 12 April | Burwood NSW | RN, EN > Palliative care | 16 – 17 May | Nowra NSW | RN, EN > Mental health case management skills | 30 – 31 May | Burwood NSW RN, EN > Perioperative anaesthetic nursing | 21 June | Tweed Heads NSW | RN > Understanding team nursing and leadership | 20 – 21 June Burwood NSW | RN only

10 | THE LAMP MARCH 2013 1800 COLLEGE (26 55 343) Australian College of Nursing

“Shifting hundreds of thousands of workers back into the Queensland IR system will leave them vulnerable to losing pay and conditions such as penalty rates” — Ged Kearney, ACTU Australia

Campbell Newman’s power grab The Queensland state government’s attempt to seize industrial relations powers from the federal government, and return almost 300,000 small business employees to the state IR system, will leave Queensland workers worse off says the ACTU. ACTU President Ged Kearney says the Campbell Newman Government has already shown its contempt for workers by sacking 14,000 public servants since it was elected. “Shifting hundreds of thousands of workers back into the Queensland IR system will leave them vulnerable to losing pay and conditions such as penalty rates” Ms Kearney said. “The National Retail Association is already calling for the Queensland government to reduce penalty rates and casual loadings as part of this change. “The Newman Government could then rip apart the state award system to suit employers.” Ms Kearney said the Newman Government’s close relationship with business groups made it likely that a new IR system would be used to cut workers’ entitlements. The Chamber of Commerce and Industry Queensland is already on record as opposing weekend penalty rates for all businesses, limiting overtime, and reintroducing individual contracts that take away pay and conditions.


WHAT’S ON MARCH 2013 ——— • ———

Computer Essentials for Nurses and Midwives – 1 day 3 April, Randwick Seminar suitable for all nurses and midwives

Members $85 Non-members $170 ——— • ———

Are you meeting your CPD requirements? – ½ day 5 April, Penrith 18 April, Lismore Seminar is suitable for all nurses and midwives to learn about CPD requirements and what’s involved in the process.

Members $40 Non-members $85 ——— • ———

Practical Positive Leadership – 3 days 10 April, Waterloo, Sydney 23 April, Penrith A workshop specifically designed to meet the leadership needs of nurses and midwives.

Members $250 Non-members $400 ——— • ———

United States

Nurses hit the big screen A new feature-length documentary Nurses: If Florence Could See Us Now premiered in Los Angeles late last year. The film, which is almost entirely comprised of unscripted interviews with nurses, was conceived by Kathy Douglas, founder and president of On Nursing Excellence (ONE), a nonprofit organisation that produced the film. “The film is never from any point of view other than that of the nurse. It is just nurses talking about how they feel about their work in a way that is authentic and spontaneous,” she said. Douglas’s motivation for creating the film came largely from a sense that both the public and policymakers needed to have a clear sense of the work nurses do – especially during the current discussion of health care reform and the future of health care in the United States. “I very much hope that nurses will watch the film and take some time to stop and feel proud of what they do and be re-inspired,” she said. “One of the key messages that comes out in the movie, starting with Florence, is that one person can make such a difference,” says Douglas.

Aged Care Seminar Series – 1 day 10 April, Katoomba Seminar is suitable for all RN, EN and AiNs.

Members $75 Non-members $170 ——— • ———

Legal and Professional Issues for Nurses and Midwives – ½ day 19 April, Lismore 29 April, Gymea Topics covered include the Health Practitioner Regulation National Law, potential liability, the importance of documentation, the role of disciplinary tribunals and writing statements.

Members $40 Non-members $85 ——— • ———

Policy and Guideline Writing – 1 day 19 April, Waterloo, Sydney Seminar is suitable for all nurses and midwives.

Members $85 Non-members $170 ——— • ——— To register or for more information go to or phone Carolyn Kulling on 1300 367 962

View the trailer on YouTube THE LAMP MARCH 2013 | 11


Strong support for 2013 PHS claim Members have endorsed the NSWNMA Public Health System (PHS) draft claim that aims to deliver a 2.5% pay rise and the extension of ratios into new specialty areas, as well as improvements in some hospitals. VOTING CLOSED ON THE CLAIM ON 1 MARCH. As The Lamp goes to print 214 NSWNMA Branches in the public health system have voted in favour of the proposed claim. One branch voted no. There were 235 Branches eligible to vote. The vote rounded off months of consultation and discussion with members through surveys, branch meetings, discussion groups and focus groups. An important facet of the claim is the further advance of ratios, building on the historic win in the 2010 PHS pay and conditions campaign. The claim seeks to extend ratios into specialty areas such as paediatrics and neonatal intensive care units, the improvement of ratios in all hospitals to the same level as peer Group A, and a new mechanism to guarantee face-toface, nurse-to-patient hours in community nursing. The NSWNMA will also seek a 2.5% pay increase so nurses and midwives wages’ keep pace with forecasted inflation. The claim also seeks a funding commitment for a further 275 full-time equivalent CNEs/CMCs working across seven days and all shifts. Other components of the claim include guaranteed nursing staff for patient specials, a change to a better system to calculate the occupancy of a ward or unit than the current “midnight census”, and protection of the nursing workforce skills mix. NSWNMA General Secretary Brett Holmes says the endorsement of the claim is encouraging and it is now time for nurses and midwives to take our message to a wider audience. “We now need to engage the public and enlist their support to win these improvements to public health in New South Wales. The implementation of ratios in the state has been a big success. That is consistent with the considerable amount of international research which shows more nurses leads to better patient outcomes. “We also need to engage our politicians. Ultimately they decide whether resources are provided to fund the necessary improvements. “I would urge you to let your local MP know what it is like at the frontline of public health and that supporting the extension and improvement of ratios in New South Wales is the right thing to do for their constituents.”

12 | THE LAMP MARCH 2013

What members had to say at the Branch votes Maureen Buckley, Branch President at Blacktown Hospital “We had an extraordinary meeting of members to listen to the log of claims and to vote. Unanimously, every member voted for the log of claims as it was set out. I’m sure they are supportive of the idea of future patient safety.” Merilyn Lambert, RN at POW ED. “I’ve been supporting improvements in nursing for as long as I remember. I’ve been nursing for 46 years so I understand the importance of working with the union. You don’t get anything by asking, you’ve got to fight for it. We always need safer patient care. We want to keep nurses and keep patients safe.” Mary Louise White, CNC and NSWNMA Branch President at POW “We’re not just about wanting more money. It’s more about conditions and safe patient care. Those issues are the real issues and we can’t do our jobs properly unless we have those resources.” Alma Fivens, RN in general medical ward, Campbelltown Hospital “I’ve come to support the claim because I believe this will maintain patient safety. It will really retain our experienced nurses in the ward. I think what we’ve got should never be taken away from us. We should, rather, progress.”

PSA takes 2.5% after government ends attack on conditions

Claim makes sense says ratios expert Professor John Buchanan, Director of the Workplace Research Centre at the University of Sydney Business School, says the focus of the NSWNMA 2013 claim “makes perfect sense”. Professor Buchanan is the joint author of Safety in Numbers: Nurse-Patient Ratios and the Future of Health Care (Cornell University Press, 2008) and part of the team that assisted the NSWNMA with research design and analysis in the formulation of the original ratios claim in 2010. “Since the late 1990s Australian nurses have led the world in devising new ways of responding to rising work overloads and the problems this causes for patient safety and the quality of working life. “Times change and the standards concerning working conditions and patient safety must move with them to keep touch with reality. There is also a need to extend the ratios to areas previously uncovered by them. The Association has used the same methods we helped devise three years ago to identify how to improve and extend nurse-patient ratios in New South Wales today.

“The New South Wales government has passed special laws to limit public sector pay rises to 2.5% per annum. This limits the Association’s ability to achieve wage rises beyond this amount because it is not prepared to compromise established working conditions. “Given this situation, the focus of the 2013 claim on improving nurse-patient ratios makes perfect sense. It will not be easily achieved – but serious improvements in patient care and working conditions never are. Campaigns for nurse-patient ratios in Victoria and California have, however, been successful and had a huge impact in limiting the damage done by ever-increasing workloads,” Professor Buchanan said. “As a nurse working in a New South Wales public health facility you are closer to the realities of nursing work than I am. But from where I sit, if the claim resonates with you as reasonable that is because it is based on extensive evidence and consultation with nurses like yourself, and it deserves your strong and active support.”

“We also need to engage our politicians. Ultimately they decide whether resources are provided to fund the necessary improvements.”

The Public Sector Association has accepted a 2.5% pay offer after the state government backed off from its attempt to cut or overhaul workplace conditions such as sick leave, leave loading, parental leave and family and community service leave. Last year a High Court decision found that the government had a legal right to impose a 2.5% wage cap on public sector workers’ salaries. The PSA says this is still bad law and it will continue to campaign to fight the wages legislation and have the law repealed.

Register your support The NSWNMA has created a website for our Public Health System pay and conditions campaign. On the site you can register your support for the campaign and leave a comment about why we need more nurses in the New South Wales public health system. You can also view the NSWNMA TV ads that explain to the public why extending and improving ratios is so important for patient safety. Go to and register your support. Encourage your colleagues, friends and family to do so too! THE LAMP MARCH 2013 | 13


Time to care The Association’s community health campaign aims to match the growing demand for more health care at home with more time for community nurses to deliver that care.

“we still don’t have enough nurses to see all the people who need 14 | THE LAMP MARCH 2013

HELEN WILMORE HAS A SIMPLE MESSAGE for her local member of parliament: more community nurses will deliver better health outcomes and save the government money. Helen, a women’s health nurse at Randwick Community Health in Sydney’s east, and fellow nurses are arranging to visit their state MP to seek support for the Association’s campaign for more time to care in community nursing. Helen suspects the average politician is unaware of the wide range of services provided by community nursing, or the extent of unmet demand for health care at home. “There has not been enough public awareness about the role of community nurses. People often do better if they can be cared for at home rather than in hospital, where they are more likely to pick up infections,” Helen said. “And keeping people out of hospital is a big economic save for the government.” As a women’s health nurse in a community setting Helen focuses on preventative health care such as pap smears, breast checks, contraceptive advice and pregnancy care. With 96 nurses and allied health workers, Randwick Community Health provides more than 50,000 “occasions of service” per year. “However we still don’t have enough nurses to see all the people who need seeing and spend adequate time with those we do see,” Helen said. “A lot of our day is taken up with administrative work such as phone calls, copying notes into the computer and collecting statistics. “We need to generate local activity to make politicians and the wider community understand the need for, and benefits of, more community nurses.” A key message will be the need to set a maximum four-hour limit on faceto-face patient contact, averaged over a week – a central plank of the Association’s campaign. Helen and colleagues are lining up volunteers to do a letterbox drop, and collecting stories from patients testifying to the value of community health services.These may help to interest the local media in covering the Association’s campaign. They will also spread the word among local organisations they are in regular contact with, such as neighbourhood centres, early child care and day care centres, and aged care centres.

Nurse shortage in mental health The public needs to understand the “knockon effect” of understaffing in community mental health, says an experienced nurse. “OUR JOB IS TO REMIND THE PUBLIC THAT WHAT WE do is very important and when we can’t do it properly, everyone suffers,” says community mental health nurse Jeff Furolo. Jeff is president of the Association’s Illawarra Shoalhaven mental health nurses’ branch and has worked as a community mental health nurse for most of his career. He worries that forcing understaffed services to take on more and more patients is eroding the quality of patient care. “Case managing mental health patients is very serious, time consuming work, with increasingly complex cases that other services cannot deal with, or do not want to deal with,” Jeff told The Lamp. “The time needed to look after mental health patients in the community has grown over the past 10 to 15 years, partly because of more onerous documentation requirements. “Despite this we are expected to take on more cases, meaning patients don’t get the care they need in a timely fashion, or their care may be interrupted.” Jeff says the challenge is to explain to the public that, as a result, there are worse outcomes – not only for patients but for many others in the community. “We nurses don’t like saying ‘no’ to the people who need us so eventually we burn out and sometimes even leave the service. That’s bad for the staff who remain and the service as a whole.” This has a knock-on effect for families, carers, police and ambulance services and hospital emergency departments. “The shortage of community mental health nurses pushes the responsibility for care onto people who are less capable of managing it.” The NSWNMA’s current statewide television advertisements, one featuring a community nurse, are laying a platform for local nurses to raise the profile of community nursing in the Illawarra/Shoalhaven district, Jeff says. “I think the TV ads are fantastic. I’m tremendously proud to be a member of this professional, effective and concerned union. “The big thing we have going for us is that nurses are very well regarded and people know that we really do care. But we will need as many community nurses as possible to pitch in, for this campaign to work.”

seeing.” THE LAMP MARCH 2013 | 15

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Push for safer community health COMMUNITY NURSES HAVE AN OPPORTUNITY to win safer workloads if they get behind the NSWNMA’s current campaign to generate public support for the sector, believes women’s health nurse Linda Oliver. “Community nurses desperately need a mechanism that deals with the time we spend face-to-face with clients,” says Linda, one of more than 40 nurses based at Mount Druitt Community Health Centre in western Sydney. “Nurses at our centre work extraordinarily hard to try and meet KPIs without having a workable tool that allows them to maintain client safety. “Our campaign for a four-hour daily limit on face-to-face patient contact, averaged over a week, is a reasonable solution.” As the delegate of the Association’s Western Sydney Community Nurses’ branch, Linda attended a nurses’ forum that opted for the mandatory four-hour daily limit. “We thought four hours per day would give us the flexibility to achieve safer patient care in the wide variety of nursing specialties that come under the community umbrella. “There was a lot of discussion to find one formula that would work across diverse areas like health promotion, primary care and prevention, wound care assessment and treatment, and consulting on palliative care. “We needed something that would fit with a range of services including home visits, running a community wound care clinic, doing a mental health assessment, or providing midwifery services for our antenatal clients.” Most of Mount Druitt Community Health Centre’s work is in child and family health and chronic and aged care. Nurses also cover women’s health, palliative care, dementia, heart disease and obesity and mental health.

Capping face-toface patient contact is a flexible solution for community nurses of all specialties.

Linda says capping face-to-face hours should allow community nurses enough time for the long and often frustrating daily task of entering required patient information, such as clinical notes, referrals, management plans, medications and alerts, onto an electronic database. Also time-consuming is the need to work via interpreters – almost 70% of Linda’s clients in 2012 were from non English-speaking backgrounds. “It’s not just a translation problem, some concepts of health care and wellness are completely new to some of these women,” she said. “Our job in this campaign is to make the general public and politicians aware of the importance of community health work, in helping to keep people out of hospitals and nursing homes and raising the level of wellness in the community. “Politicians need to understand that nursing doesn’t only take place in hospitals. Many of the clients we see are damaged by their lifestyles so we do a lot of work around nutrition, diabetes management and obesity.” The Western Sydney Community Nurses’ branch plans to use a phone conferencing system to allow nurses at different community health centres to take part in branch meetings via the telephone. “There are lots of reasons why people can’t physically get to lunchtime branch meetings. Often they feel they are too busy or they are not allowed to drive work cars to union meetings. “We hope phone conferencing will maximise participation in meetings and the campaign activities that flow from them.”

“politicians need to understand that nursing doesn’t only take place in hospitals.” THE LAMP MARCH 2013 | 17


Visit your MP to gain support for ratios NSWNMA members have begun visiting their local MP to explain the need to extend and improve nursepatient ratios in New South Wales. Here, members report to The Lamp about the response they have received from their local MP. Roz Norman from Tamworth Hospital meets with her local MP, Kevin Anderson.

18 | THE LAMP MARCH 2013

Michelle Callard, Cathy Taylor and Jeff Crebert from Campbelltown Hospital visit their local MP Bryan Doyle.

“Bryan did commit, to a visit to Campbelltown Hospital to talk with our nurses on the floor.” Bryan Doyle (Liberals, Campbelltown)

A positive hearing but party line rules Jeff Crebert, Michelle Callard and Cathy Taylor from Campbelltown Hospital visited their local MP Bryan Doyle. “He says he is very supportive of nurses and will do whatever he can at a local level but insists he follows party lines,” said Jeff. “He was prepared to listen to our claim and local issues that supported our request for increased staffing.” Jeff asked Mr Doyle if he would lobby Macquarie Street on behalf of nurses. Mr Doyle was non-committal. “Bryan did commit to a visit to Campbelltown Hospital to talk with our nurses on the floor. “Bryan comes from a legal and public servant background as a former police officer. He was keen to ‘get the facts’ before making any decisions. “The delegation felt it had a positive hearing. Bryan said he would be happy to meet with nurses again.”

Garry Edwards (Liberals, Swansea)

“Kevin committed to bringing up the issue of ratios and the need to encourage RNs to rural and regional areas whenever he can.” Kevin Anderson (Nationals, Tamworth)

Supportive of nurses Roz Norman from Tamworth Hospital met with her local MP, Kevin Anderson. “Kevin is very supportive of nurses and will do whatever he can at a local level. “He committed to bringing up the issue of ratios and the need to encourage RNs to rural and regional areas whenever he can. He also said he would attend any activity to which he is invited if he is available.’

Understands nursing issues Terry Head, RN and Elaine Lane from Belmont Hospital met with Garry Edwards, the Liberal member for Swansea. Terry said he found the meeting very encouraging. “Garry already has some knowledge of nursing issues as he has a wife and daughter who are RNs,” he said. “Garry supports the campaign to align ratios and was very interested in what is going on at Belmont Hospital. He was a patient there last year. “He is also supportive, in theory, of a wage rise. He clearly understands the disparity in city versus regional hospitals when it comes to ratios and pledged to discuss this matter with colleagues when he’s down in Sydney for parliament. We also talked about skill mix and the importance of getting it right. “I think if all MPs were married to RNs we would be a lot better off!”

“Garry supports the campaign to align ratios. He also supports a pay rise.” THE LAMP MARCH 2013 | 19


Dianne Lohman, Jennifer Clarke, and Linda Weir, members of the Kempsey District Hospital Executive.

Andrew Stoner (Nationals, Oxley)

National leader reminded of past promises

“He said it was our job to convince NSW Health that we needed this increased staffing.” 20 | THE LAMP MARCH 2013

Three members of the Kempsey District Hospital Branch Executive, Dianne Lohman, Linda Weir and Jennifer Clarke, met with New South Wales Nationals’ leader, and state Deputy Premier, Andrew Stoner, to explain the goals of the 2013 NSW Award Campaign. “Our members wanted us to explain to Mr Stoner how it may affect the nurses in our Kempsey electorate and thus the patients on the Macleay,” said Jennifer Clarke. “We explained that rural nurses felt left out during the last award campaign. They saw that the city hospitals and base hospitals

have support staff whereas a lot of smaller country facilities do not.” Jennifer said the delegation asked for Mr Stoner’s assistance to get more support for rural nurses through improved staffing and skill mix. “He said it was our job (the NSWNMA) to convince NSW Health that we needed this increased staffing.” Jennifer said they explained to the Deputy Premier about multiple assignments and how it mainly affects country nurses who do not wish to take positions that are in

“Ms Sage told the delegation that she could do little to influence matters in relation to the nurses’ negotiations.” Roza Sage (Liberals, Blue Mountains)

I have no influence

several areas. For example, working at the same time in the Emergency Department and Community Health. “He actually appeared shocked and disgusted at this. He said that he was going to immediately contact Melinda Pavey – the Parliamentary Secretary for Regional Health – to talk to her about multiple assignments.” Jennifer says the meeting was conducted in a cordial atmosphere. “We began the meeting by congratulating him on his 10th anniversary as leader of the Nationals on March 31 2013. During the meeting he told us that he thought ‘we are all angels’.”

Jennifer says that towards the end of the meeting she told Mr Stoner that she had read his maiden speech to parliament. “He groaned and said ‘you are going to quote me now?’ But he went on to say ‘what I said is just as true now as it was then’. “This is what I quoted back to him: ‘Enough of problems. I wish to focus on solutions. The government must also take heed of the population growth and demographics of the Mid-North Coast and fund health services accordingly. The government holds in its hands the ability to overcome all these issues, to provide for the residents of Oxley a standard of life similar to that of those living in the city’.”

Garry Inglis, RN Mental Health, Peter Buckney, RN Rehabilitation Unit and Peter Lammiman, EN Mental Health Worker – all from Blue Mountains Hospital, Katoomba – visited their local MP, Roza Sage. Garry said Ms Sage told the delegation she could do little to influence matters in relation to the nurses’ negotiations. “We responded that as our locally elected member of parliament we expected her to convey the issues raised with the appropriate representatives in her government’s Health Ministry,” he said. Garry said all the delegates conveyed their personal experiences of how stretched nurses were, giving examples of how unsafe working conditions had occurred and continue to be the case due to nursing shortages and skill mix issues. “We emphasised that safe work loads and the Association’s campaign called upon the Health Ministry to acknowledge the need to build upon nursing ratios. We explained that safe, effective nursing care depended on this framework and that this framework of nursing care needed to be extended to include nurses in the community as well as other areas like paediatrics and ED.” The delegates raised the issue of disparities in staffing levels and ratios in rural settings, which discriminates rural communities from their metropolitan counterparts. “We pointed out that the Auditor-General of New South Wales had found an extra $680 million in the last budget. Ms Sage disputed this statement saying it was the last Labor government’s accounting that had led to this oversight, as well as implicating the federal Labor government as having its hand in this matter.” THE LAMP MARCH 2013 | 21


Research links ratios to better outcomes A massive and growing body of research in a wide variety of international settings is demonstrating a strong link between higher levels of nurse staffing and lower hospitalrelated mortality, lower incidences of failure to rescue, and better and safer patient outcomes.

The Lamp looks at some of these studies. T H E E V I D E N C E I S M O U N T I N G T H AT inadequate nurse staffing levels lead to an increase in negative outcomes for patients and ultimately a greater burden of cost to the health system and society. One of the most compelling analyses comes from an American review by RL Kane and colleagues of 94 separate studies conducted between 1990 and 2006. This extensive pooled data threw up some powerful conclusions. The review assessed the effect of increasing RN skill mix and concluded that “every additional RN FTE Per Patient Day was associated with a relative risk reduction in hospital-related mortality by 9% in ICUs and 16% in surgical patients.” Kane estimated that an increase by one full-time RN per patient day would save five lives per 1000 medical patients, and six per 1000 surgical patients. Every additional patient per RN per shift was associated with a 7% increase in relative risk of hospital-acquired pneumonia, a 53% increase in pulmonary failure, a 45% increase in unplanned extubation, and a 17% increase in medical complications. According to the study, “one additional patient per RN per shift would result in 12 additional cases of failure to rescue, six cases of pulmonary failure and five accidental extubations per 1000 hospitalised patients”. The study also found death rates decreased by 1.98% for every additional nurse hour. 22 | THE LAMP MARCH 2013

Community nurses needed for research The NSWNMA is to undertake research into community health nursing as part of the 2013 Public Health System Award campaign. The participation of community nurses in this research project is vital. The research will: • Determine the factors that may impact on the quality of patient care (e.g., workload or lack of resources) in NSW community nursing organisations; and • Identify the organisational attributes that community nurses consider important for professional practice. We will be sending a link to an online questionnaire to all our community health nurse members later this month. The questionnaire will take about 15 minutes to complete and neither you nor your organisation will be identifiable. For more information contact Dr Thomas Harding at

SIMILAR RESULTS IN EUROPE There has been consistency in results found across different continents. A survey of 1400 RNs in Finland and the Netherlands by Hinno, found that the incidence of patients falls increases when the patient to RN ratio is five and above. “Most of noted adverse outcomes for patients occurred when RNs were responsible for five or more patients. This applies to incidence of patients falling down, falling off a chair, out of bed etc and leaving the unit without permission” the study found. In the Netherlands, the occurrence of hospital infection progressively increased with increases in the patient-to-nurse ratio. A massive cross-continental survey of nurses in the United States and Europe by Aitken and colleagues, backs up these analyses. Aitken’s surveyed US nurses in 488 general acute hospitals, and European nurses in 12 countries and 617 hospitals. The study also looked at patient satisfaction data. “Our results suggest that the associations between nursing and the quality and safety of hospital care are remarkably similar across Europe and in the US. Thus, efforts to improve hospital work environments and quality of care in any of these countries could be effective elsewhere,” the report says. The study found that “each additional patient per nurse increased the odds of nurses reporting poor or fair quality care, and poor or failing safety grades.

“Patients in hospitals with higher ratios of patients to nurses … were less likely to rate their hospital highly and to recommend their hospital.” Another US team led by Bobay (2012), looked at 16 medical/surgical units in four magnet hospitals to study the effect of staffing levels on post-discharge presentation to ED within 30 days. It estimated the likelihood of a patient representing or being readmitted. Bobay found that the odds of an unplanned related ED visit following discharge decreased by 45% for every increase of 0.71 RN hours per patient day.

“There is growing evidence that clearly demonstrates that inadequate nurse staffing levels lead to an increase in negative outcomes for patients.” — Brett Holmes

RESEARCH VINDICATES OUR RATIOS CAMPAIGN NSWNMA General Secretary Brett Holmes says the amount of empirical evidence that shows the value of ratios to patient care is now formidable. “There are now a large number of significant studies – from the United States and Europe as well as from Australia – that describe the significant link between nurse-topatient ratios/nursing hours per-patient-day and patient outcomes. “There is growing evidence that clearly demonstrates that inadequate nurse staffing levels lead to an increase in negative outcomes for patients. It also leads to a greater burden of cost to both the healthcare budget and society. “These results are not that surprising. A nurse is the only member of a healthcare team that is a continuous presence at the bedside. So the nurse is the most likely person to pick up a deterioration in a patient’s condition and initiate a response that minimises adverse events and negative outcomes for the patient. “The research vindicates our campaign to have ratios implemented in New South Wales and increases our determination to see ratios strengthened and extended.”

Ratios and more RNs boost patient outcomes There have been numerous studies that show the benefit of higher nurse staffing and a higher proportion of RNs in the skill mix. URINARY TRACT INFECTION (UTI) — A study of 235 Californian hospitals by Esparza (2012) found that with increased nursing hours per patient day (NHPPD) the odds of UTI decreased 1.013 times, and as RN proportion of skill mix increased, odds of UTI decreased by 4.25 times. PRESSURE ULCERS — Australian research by Duffield (2011) using data from 80 units in 19 NSW hospitals found increased RN/CNS (Clinical Nurse Specialist) staff was associated with significantly decreased rates of pressure ulcers and increased RN/CNS staff as a proportion of nursing hours was associated with significantly decreased rates of pressure ulcers. PNEUMONIA — A US meta-study by Kane (2007) reviewed data from 94 studies conducted between 1990-2006 and found that every additional patient per RN per shift was associated with a 7% increase in relative risk of hospital-acquired pneumonia. UPPER GASTROINTESTINAL BLEEDING — A retrospective study of three adult tertiary hospitals in Perth by Twigg (2010) utilised 236,454 patient records and 150,925 nurse staffing records and found that increased NHPPD lead to a 37% decrease in ulcer/gastritis/upper GI bleeds. FAILURE TO RESCUE — An analysis of data by Aitken and colleagues (2013) from 10,184 nurses and 232,342 patients in 168 hospitals in the US found that each additional patient per nurse was associated with a 7% increase in failure to rescue in surgical patients. HOSPITAL MORTALITY RATES — Twigg’s Perth study also found that increased NHPPD patient day was significantly associated with a 25-26% decrease in mortality rates.

THE LAMP MARCH 2013 | 23


Alarm over coal dust Nurses have joined a Newcastle-based community campaign to warn of the health hazards from increasing coal shipments.

A PLAN TO BUILD A FOURTH COAL TERMINAL in Newcastle Harbour has prompted local nurses to join a community campaign warning of the health risks from coal dust. The Stockton branch of the NSW Nurses and Midwives’ Association has called for action to address health issues related to coal dust pollution, and the union’s statewide Committee of Delegates has endorsed the call. The proposed fourth terminal, known as T4, is to be built next to existing coal loaders less than one kilometre from the Ageing, Disability and Home Care service’s Stockton Centre, which houses about 400 people with intellectual disabilities. NSW Health has raised serious questions about the environmental assessment of the T4 Project and expressed concern that neither the Health Ministry nor Local Health District was adequately consulted in the assessment process (see story page 25). NSW Health said complaints about coal dust from residents of suburbs near the port 24 | THE LAMP MARCH 2013

had increased along with the expansion of Newcastle coal export facilities. Newcastle’s coal export capacity has almost tripled from 77 million tonnes per annum (Mtpa) in 1997 to 210 Mtpa in 2011. If approved, T4 will be capable of handling another 120 million tonnes of coal per annum. The Stockton branch of the NSWNMA says the health of people living and working near coal mining, transport, storage and handling facilities, is potentially at risk from coal dust. Branch president Michael Grant said NSW Health had expressed concern that particle pollution from coal dust already exceeded national standards in the Upper and Lower Hunter, while a study at one of the existing coal terminals showed an unexplained cancer cluster. “These health concerns must be addressed before the New South Wales government approves a new coal terminal for Newcastle,” Michael said.

Another Stockton Centre nurse, Cathy Burgess, says local air quality improved for a time after the BHP steelworks closed in 1999. “However with the massive increase in coal traffic and dust, air pollution now is at least as bad, if not worse than when the steelworks were in operation,” Cathy, a resident of the suburb of Stockton for almost 20 years, said. Cathy is a member of the Stockton Community Action Group, one of 16 Newcastle and Hunter Valley organisations united in the Coal Terminal Action Group. She says T4 coal stockpiles will be uncovered, resulting in more dust blowing onto Stockton Centre and suburbs. T4 will also result in 52 additional, uncovered, 90-wagon coal trains travelling in and out of Newcastle every day, and more coal dust and diesel pollution in suburbs along the railway. T4 is a project of Port Waratah Coal Services (PWCS), which operates two of the three existing coal terminals. Major

photograph: SIMONE DE PEAK/Fairfax Syndication

Cathy Burgess and Ras Berghout of the Coal Terminal Action Group distribute flyers in Newcastle.

owners of PWCS are mining giants Rio Tinto and Xstrata and Japanese investors. T4 will cost more than $5billion and requires state government approval. Federal government approval is also needed because the site is next to internationally significant wetlands and bird habitat. POLLUTION MONITORING Particle pollution from coal dust is monitored at several locations in the Hunter Valley and regularly exceeds the national standard for coarse particles with a diameter less than 10 microns, which can lodge in the upper throat and bronchi, according to the Hunter Community Environment Centre’s Dr James Whelan. He said the same monitoring stations also indicated that pollution regularly exceeds World Health Organisation (WHO) guidelines for fine particles with a diameter of less than 2.5 microns, which can reach down to the alveoli in the lungs. “All particle pollution can adversely affect the respiratory and cardiovascular sys-

tems and the latest WHO air quality guidelines identify fine particles as one of the most dangerous pollutants for human health,” Dr Whelan said. He said community groups raised $6000 to conduct their own monitoring of air pollution up to 400 metres from the coal train corridor, because the environmental assessment done by consultants for the T4 project only studied pollution within 20 metres of the rail corridor. “The University of Newcastle is still looking at the results but the initial analysis shows particle pollution levels above the national standard in most locations up to 400 metres from the rail corridor. “This would pose a potential health hazard for many more residents than indicated by the T4 consultants’ limited study of rail corridor pollution.” Dr Whelan said he was not confident the Planning Assessment Commission would recommend against the project but hoped it would at least impose tough conditions.

“The Planning Assessment Commission recently recommended against a mine extension in the Hunter Valley. The state government asked them to reconsider their decision and two government departments were asked to resubmit their arguments. One department switched its stance from opposition to support for the bigger mine.” Meanwhile there is growing concern that while public health services in Hunter Valley mining regions are under increasing strain, these districts are being denied their fair share of tax, royalty and other revenue from the hugely profitable mining industry. The October 2012 edition of The Lamp reported that the Hunter Valley local government areas of Singleton and Muswellbrook contribute more to NSW state government revenue than any other part of the state, while receiving the lowest level of government spending. Singleton and Muswellbrook have the state’s highest rates of cardiovascular disease hospital separations. THE LAMP MARCH 2013 | 25


Worry in the playground Children “at risk” from uncovered coal wagons.

“Energy policy must take into account the public health impacts of coal.” 26 | THE LAMP MARCH 2013

COAL DUST FROM UNCOVERED TRAIN wagons is inhaled by more than 23,000 students at 60 schools located within 500 metres of the railway from Hunter Valley mines to the port of Newcastle. “It means students spend their lunchtimes playing while breathing air filled with coal dust emanating from passing trains,” commented local newspaper the Newcastle Herald, which has been campaigning to have covers put on coal wagons. “Many also spend their days in classrooms without air-conditioners or air filters to protect them from damaging particulates that are contained in the dust,” the paper said. Singleton GP Dr Tuan Au has been investigating a link between open-cut coal mining operations and rising respiratory illness in his community. His 2009 study of 683 primary and secondary students in the Singleton area found one in six had diminished lung function. In nearby Branxton, where children were further from the mines, only one in 20 had lower lung function. Dr Au said particulates in coal dust had been shown to damage lungs – especially in children. “Energy policy must take into account the public health impacts of coal while meeting our energy needs,” he told a public meeting. He drew a parallel with asbestos: “We knew the impact of asbestos by 1919 but it took us until 1970 to decide to stop mining it. By then the damage was already done.” Dr Au told the Newcastle Herald that before any new coal mine opens up, baseline health studies of local people should be done to determine their level of asthma, cardiovascular disease, cancer, premature births and psychiatric problems and that the findings form the basis of long-term studies. He also argued that everyone in an area impacted by a coal mine should be entitled to a free annual health check. “The government should investigate sending local school children to a camp away from coal mining areas for a few weeks each year, to get some fresh air,” he said. “People are constantly telling me that when they go away from Singleton for holiday they don’t need to use a nebuliser or any asthma treatment, and their sinus gets better.”

Health expert slams pollution study

Protestors oppose the proposed fourth terminal (T4).

Flyer urging Newcastle residents to fight T4

NSW Health was not adequately consulted in the environmental assessment of Newcastle’s controversial coal loader, says professor. A SENIOR NSW HEALTH OFFICIAL HAS criticised inadequacies, wrong assumptions and lack of consultation in the environmental assessment of Newcastle’s proposed fourth coal terminal,T4. He is Professor David Durrheim, Service Director-Health Protection for the Hunter New England Local Health District and Professor of Public Health Medicine at the University of Newcastle. The World Health Organisation describes him as an expert adviser and consultant, including on public health research issues. Professor Durrheim wrote to the NSW Department of Planning and Infrastructure about the environmental assessment done by consultancy firm EMGA Mitchell McLennan, for the T4 owner Port Waratah Coal Services. Professor Durrheim described the expansion of coal loading facilities at Newcastle port as “one of the greatest stated concerns for residents in neighbouring suburbs” with

“frequent inquiries from the community regarding noise and dust.” He said the environmental assessment appeared to overstate the level of community support for the project, and included contradictory statistics about the claimed level of public support. He added: “It is of concern that neither the NSW Ministry of Health or Hunter New England Local Health District were directly engaged in the stakeholder consultation” and “in future we would appreciate being included as a stakeholder agency in any developments that involve emissions to air, water or soil that could have … an impact on public health”. Professor Durrheim said even a minimal increase in particle pollution due to the T4 project “needs to be balanced against both a community and public health expectation that particulate levels should be reduced in inner-city Newcastle, not increased.” Professor Durrheim said the T4 project

would bring a “substantial increase” in coal train traffic and made a number of criticisms of the environmental assessment’s findings relating to air pollution from rail transport of coal. These included the assessment’s failure to consider pollution from trains returning to the Upper Hunter Valley from the port, and failure to consider diesel exhaust. The assessment only considered the impact of coal dust on about 100 houses within 20 metres of the rail corridor. Professor Durrheim said coal dust beyond 20 metres of the corridor “needs to be carefully considered” for its impact on air quality and “necessary mitigation strategies”. The assessment claimed the T4 project would only result in a marginal increase in noise. “Given the current noise levels are not well tolerated by the community, it calls into question the value of noise modeling that predicts a marginal increase will be acceptable,” Professor Durrheim commented.

THE LAMP MARCH 2013 | 27


No reform without nurses Federal health minister Tanya Plibersek says nurses are critical to the success of health care reform.

FROM MEDICARE LOCALS TO DISABILITY and Aged Care services, nurses will be instrumental in delivering some of the biggest changes to the Australian health system since the Whitlam Government introduced Medicare in 1975. These changes are focused on preventive care at community level, backed by better resourced acute care hospitals. But they will also require a major effort to train and retain nurses. “I see the role of nursing as critical for a few reasons,” Ms Plibersek told The Lamp in an exclusive interview. “We have workforce shortages in Australia and will continue to have them in some locations if we don’t continue to train more nurses and more doctors. But we also need to keep people already in the area engaged and interested and able to change their career according to different preferences in their lives and different life circumstances.” She says expanding and developing the roles of nurses is an important part of keeping them in the health workforce. “It’s also an important part of providing great services to the community. We know a lot of patients prefer to deal with a nurse, particularly if you’re talking about chronic disease management or mental health.” Describing the introduction of the National Disability Insurance Scheme, due to be introduced by May 2013, Ms Plibersek said:“It’s as big a deal as Medicare, so there will be a need for an expanding disability services workforce. “Having said that, I don’t want to underestimate how important the shortage of people to work in disability and ageing is right now because of the disparities we see there. The cuts the New South Wales government is making in a whole range of 28 | THE LAMP MARCH 2013

different areas are hugely concerning for patient care. You can’t cut $3.5billion out of the state’s health without compromising patient care. “The New South Wales government says it will redirect some of that but that’s still a substantial cut. That $3.5billion has to come from somewhere and in part it’s coming from wages and conditions, in part from fewer services. Anyway you look at it, it’s a problem.” FIRST HAND EXPERIENCE Ms Plibersek’s first hand experiences with nurses reflect her own health needs. Her third child Louis was born at the Royal Hospital for Women in Randwick on October 1, 2010. With 75 Labor MPs to the Coalition’s 74, opposition leader Tony Abbott granted her a “pair” – meaning an absent MP’s vote in parliament is neutralised by sidelining an MP from the other side – for just four weeks. This placed young Louis very much at the centre of power, with his mother breastfeeding and back at work full time within three months of his birth. Some of the less usual trappings of the ministerial office – playpens, bassinets and nursing bras – were very much in line with her portfolio duties at the time as Minister for Human Services and Social Inclusion. Ms Plibersek acknowledges that having a nanny, plus the introduction of childcare facilities in Federal Parliament as more women of child bearing age have been elected, made her more fortunate than many working mums. Though with such a fragile majority, it must have been tough to stick with her philosophy of breast is best for mother and child for the first year.

Hardly surprising then, that she counts time with lactation consultants among her best personal experiences with nurses. “Like most people I’ve had experiences both being in hospital and having family members in hospital and I see the extraordinary dedication of nurses who look after patients,” she said. “I’d say that the particularly good experiences I’ve had have been in two areas. The first with midwives and lactation consultants and with nurses who’ve gone on to specialise in looking after women before, during and immediately after the birth of their babies. I’ve had almost universally terrific experiences with them. “And the second area is with palliative care. Anyone who has been with someone as they’ve gone through the last stages of their lives, in and out of hospital and in and out of palliative care, would see the comfort and support from a nurse that goes beyond medical care. The emotional support nursing staff in palliative care give to patients and their families is irreplaceable, absolutely irreplaceable. You can’t put a dollar value on it.” POLICY OF PREVENTION The federal government’s health policy emphasis on prevention is not necessarily an easy option in the complex field of powerful special interest groups that all administrations must confront when big changes are under consideration. And there are few more powerful lobby groups than big tobacco. Ms Plibersek says the government’s plain packaging measures have removed the last advertising opportunity from tobacco companies. “The fronts of cigarette packs were like

little mobile billboards,” she said. “The big tobacco companies see this as the last gasp of their dying industry and they’re pulling out all the stops to oppose our measures. “They took us all the way to the High Court, and while we were pleased that we were successful, we still have international action against us, where cigarette companies are working hand-in-hand with some tobacco exporting countries to take us to the World Trade Organisation or use bilateral trade agreements against us. “So it’s been a tough fight and it’s still on. I don’t know that we can comfortably celebrate the victory yet.” The stakes are high on both sides, with the treatment of smoking-related death and disability costing Australian taxpayers around $31.5billion a year, and lung cancer the largest cancer killer across the population. MEDICARE LOCAL A less internationally significant, but equally ground breaking, change in the delivery of medical care has been the focus on Medicare Locals. “This is where we are really making primary health care decisions at a local level, working beyond the traditional GP practice, including nurses and allied health professionals in order to provide integrated and comprehensive primary health care services,” Ms Plibersek said. “We know that countries that spend a similar proportion of their overall budgets on health do better if more of that spending is at the primary health care end, keeping people healthy and out of hospital. “It doesn’t mean that we don’t invest in acute hospital services.We do.We’ve massively increased the funding to the hospital sector and will continue to do so. “But if we can keep people healthy and out of hospital that will be a great achievement and the emphasis on Medicare Locals and GP super clinics is part of that.” Last year Ms Plibersek announced a $4billion dental health scheme that included $2.7billion for the treatment of children and $1.3billion to states and territories to expand existing services. “I’m incredibly proud of the investment we’re making in dental. Essentially it will be as easy for 3.4 million kids to see a dentist as it is now for them to see a GP. We’ve also got a massive boost for the public dental systems in the states to treat more needy patients. “I’m also proud of the expansion of the bowel cancer screening program and Gardasil for boys is another favourite of mine. It means we will have better protection for girls and boys from cancers related to the human papilloma virus.”

THE LAMP MARCH 2013 | 29


Getting involved to tackle Sydney issues The NSWNMA and the Sydney Alliance are working together to shape the future of Sydney’s health system.

IN 2012, THE SYDNEY ALLIANCE FACILITATED improvements to three major Sydney train stations, gained police cooperation to pilot a “stop and search receipting system” and secured the withdrawal of a state parliament bill that would have forced retail workers to spend time away from their families on Boxing Day. Meanwhile, in Sydney’s south-west, six medical centres around Liverpool and Fairfield are upgrading their car parks, thanks to the efforts of the Alliance, meaning patients will no longer have to illegally park when seeking urgent medical attention. A delegation of NSWNMA members and more than a thousand other people attended the second Sydney Alliance 30 | THE LAMP MARCH 2013

assembly in October. Among them was president of the Quality Aged Care Action Group (QACAG), Margaret Zanghi. “I think action takes a long time and it’s a good thing that the Alliance exists,” Margaret told The Lamp. The QACAG president said she was impressed with the motivation among Sydney Alliance members and described the second assembly as an “extremely wellorganised event”. “There were quite a number of members from the Nurses and Midwives’ Association there who were concerned about aged care,” Margaret said. She is hopeful that staffing ratios and pay parity in aged care will be addressed in future through the NSWNMA’s

partnership with the Sydney Alliance. “Registered Nurses [in aged care] are not paid the amount that they’re paid in public hospitals and so you can’t attract people into aged care,” Margaret explained. “Most things that go wrong in nursing homes are to do with the fact that there isn’t enough staff on the ground and that’s the main issue. “Things are far from okay and one of the biggest issues is staffing. We need the ratios in staffing,” she said. According to Sydney Alliance organiser David Barrow, the key to solving Sydney’s community support and health service problems lies with concerned individuals, like Margaret, getting involved and taking action.

The Sydney Alliance is a nonparty political organisation that brings together diverse community organisations, unions and religious organisations to advance the common good, by providing opportunities for people to have a say in decisions that affect them, their families and everyone working and living in Sydney. For more information visit

“Things are far from okay and one of the biggest issues is staffing. We need the ratios in staffing.” —Margaret Zanghi, QACAG President

“The Sydney Alliance is shaped by the people who participate in it,” David said. “The more nurses that get involved, the more that those issues that nurses care about are more likely to get raised.” As an active organiser for the Sydney Alliance it’s David’s job to join forces with concerned citizens, community organisations, unions and religious organisations to tackle the big issues plaguing Sydneysiders. “We started with a listening campaign, which nurses took part in,” David recalled. “In that listening campaign, people across Sydney and all the different partner organisations raised three issues: one was transport, one was social inclusion and one was community health and support.

“Now we’ve got districts all over Sydney where people can engage and meet people from other organisations, to work together on issues for the common good,” David said. Throughout last year, the Sydney Alliance’s Community Support and Health (CSH) groups focused on improving access to bi-lingual and Aboriginal staff and interpreters in Sydney’s west. The group held extensive research meetings, listening campaigns, organisational surveys and a forum; and plans to trial a “cultural diversity audit tool” at four organisations later this year to, “increase the capacity to recruit, support and maintain culturally diverse staffing”.

With the help of the NSWNMA, the Sydney Alliance also petitioned Parramatta Council for additional funding to continue their efforts, starting with a pilot program that aims to engage with aged care providers. While the many issues within aged care have already been acknowledged by the Sydney Alliance, organiser David Barrow told The Lamp that they don’t yet “have a critical mass of people who want to take action on it. “We don’t pick an agenda and work on it, it’s formed by the participants who take part,” David advised. “We’re going into a new year and those issues might come up, but it all depends on whether or not nurses get involved.” THE LAMP MARCH 2013 | 31


a wonderful escape to

Norfolk Island

Start paying your NSWNMA fees by Direct Debit for the chance to win a holiday for two to Norfolk Island! The prize includes return airfares for two from Sydney or Brisbane International airport with Air New Zealand; 4 nights accommodation at the boutique Poinciana Cottages; car hire; half-day orientation island tour; sunset cliff top fish fry; breakfast bush walk with NI Touring; Mastering Taste chef school with Hilli’s Restaurant & Wine Bar; Two Chimney Winery platter and bottle of wine; and a welcome pack on arrival for each person. Norfolk Island, the wonderful Island destination, is just a 2 and a half hours short flight away with Air New Zealand. There’s more to Norfolk Island than you may think. Relax over a famous “Vineyard Platter”, enjoyed with a local glass or two, on the Cellar Door verandah at the Two Chimney’s Winery; learn to cook like a chef with Hilli’s Restaurant & Wine Bar Mastering Taste Cooking Tour. Whether you are having a quick bite to eat between activities, or settling in for an extended dining experience, Norfolk Island’s dining experience

is enhanced by the seasonal, homegrown freshness of its produce. Try your best swing at the Norfolk Island Golf Course, dramatically situated along the rugged coastline. Snorkel in Emily Bay, explore around the islands historic salt farms from under the turquoise water or escape for the afternoon at one of the many picnic spots along the cliff tops. We look forward to welcoming you to our 360º of Wonder.

Contact Adventure World on 1300 295 161 or email for more information about Norfolk Island. Conditions: the prize is not transferable or redeemable in cash; prize is valid for 12 months after the draw date; flights and accommodation are subject to availability; times of tours and availability are subject to change without notice.


luxuryy holiday! Direct debit is not only the easiest and most convenient way to pay your membership, but switching over could win you a luxur Don’tt risk your membership lapsing from changing workplaces. W With ith direct debit you are always protected on the job. Don’

Membership Application forms or Direct Debit forms can be downloaded from our website www Alternatively call the NSWNMA on 8595 1234 (metro area) or 1300 367 962 (non-metro area) for more information.


ASK JUDITH Easter loading I am employed full time in a public hospital and contracted to work Monday to Friday on day shift. I am rostered to work over the Easter period. What should I expect to be paid? The following days have been proclaimed public holidays over the Easter period: 29 March 2013 (Good Friday) 30 March 2013 (Easter Saturday) 31 March 2013 (Easter Sunday) 1 April 2013 (Easter Monday). Under the conditions of the Public Health Sector Nurses’ and Midwives’ (State) Award 2011 you will be entitled to the following: 29 March 2013: 8 hours ordinary pay plus 150% public holiday loading or 8 hours ordinary pay plus 50% public holiday loading and one day added to annual leave (if elected). 30 March 2013: No payment for this day* 31 March 2013: No payment for this day* 1 April 2013: 8 hours ordinary pay plus 150% public holiday loading or 8 hours ordinary pay plus 50% public holiday loading and one day added to annual leave (if elected). * Payment of one day pay, or one day added to annual leave (if elected), if you have worked on a shift that has attracted shift penalties during your anniversary year. (see Clause 30 (ii) (d) of the Award.) However, if you are contracted as a full-time employee to work on a seven-day rotating roster basis, because you get six weeks annual leave, you should be paid as follows: 29 March 2013: 8 hours ordinary pay plus 50% public holiday loading (no other shift penalties paid). 30 March 2013: 8 hours ordinary pay plus 50% public holiday loading (no other shift penalties paid). 31 March 2013: 8 hours ordinary pay plus 50% public holiday loading (no other shift penalties paid). 1 April 2013: 8 hours ordinary pay plus 50% public holiday loading (no other shift penalties paid). If you are not rostered on, there is no payment made.

In charge but unpaid I’m an RN working in the public sector and until recently have been receiving an in-charge allowance when the NUM allocates me as in charge of clinical direction of the ward. I have now been informed that I will not receive the allowance when the NUM is on the ward, even though she is dealing with administrative issues. Senior management have directed that the NUM is responsible for all aspects of management within the unit when she is on duty. However, I am still finding that the clinical direction of the ward is falling to me and there appears to be an expectation that I will continue to do this without getting the prescribed allowance. As per clause 12 part (v) & (vi) of the Public Health System Nurses & Midwives State Award 2011. “(v) A registered nurse who is designated to be in charge of a ward or unit during day, evening or night shifts, when the Nursing/Midwifery Unit Manager is not rostered for duty, shall be paid an allowance as set out in Item 8, of Table 2 of Part B per shift. Provided that the allowance shall also be paid when

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

the Nursing/Midwifery Unit Manager is rostered on duty if the day-to-day clinical management role for the shift is delegated to a designated registered nurse/midwife. Provided further that the allowance shall also be paid in the absence of a Nurse/Midwife Manager in facilities where the Nurse/Midwife Manager undertakes the functions usually carried out by a Nursing/Midwifery Unit Manager.” To sum up, if the NUM is on the ward and undertaking day-today clinical management this allowance is not paid, but if the NUM is on the ward and designates the day-to-day clinical management to a Nurse/Midwife this allowance should be paid.

Acting up I work in a public hospital and have been acting in a NUM 2 position for the past 18 months. My permanent position is as an RN Year 8. Can you advise me how long I should be expected to continue acting in this role, and whether there is anything in the public award about higher grade duties? Yes, clause 24 Higher Grade Duty, sub-clause (ii), of the Public Health System Nurses’ & Midwives’ (State Award) 2010 states as follows: “Where an employee acts in a vacant management position covered by this Award continuously for more than six months, the employee will be deemed to be appointed to that position until such time as another appointment is made by the employer, or the employer determines that the management position will no longer be occupied. The employer shall have appropriate regard to the sharing of acting arrangements for development purposes and equitable treatment of employees, but the employer shall not rotate duties in such a manner as to avoid the intentions of this sub-clause.” Provided the position you are acting up in is vacant, (i.e. the person who previously held this position has permanently vacated the position and is not expected to return to the position), you should approach your Director of Nursing and find out what is happening with the position you currently act up in. Ask whether the position is in fact a vacant position and whether the previous incumbent is expected to return. Then, you need to ask when the position is to be filled on a permanent basis. If it is a management position, a decision needs to be made whether it will be advertised internally or externally or both, and whether it will be filled on a merit-based arrangement, i.e. through interviewing applicants. Management also have the discretion to not advertise and appoint directly to the position under certain circumstances, these are outlined in the Ministry of Health policy directive PD2012_028, page 5-6, section 2.4, last dot point on page 6. It was the Association’s intention when negotiating clause 24 that vacant positions not be left vacant for extended periods, to enable continuity of direction in relation to the manager being in a position to make decisions for both short term and long term provision of nursing services, and ensure staff morale remains positive. In other words, it removes the uncertainty many nurses face when working in an acting role. Our advice to you and other nurses in your situation is to take the initiative and bring the Award provisions to your manager’s attention. If the situation continues, ring the Association for further advice and guidance.

THE LAMP MARCH 2013 | 33


Do You Know an Enrolled Nurse Who Excells?

The Enrolled Nurse Professional Association

Call for Nominations for ENPA are offering full conference attendance (travel, accommodation and conference fees) and 12 months membership to ENPA in remembrance of Ron and his dedication and passion to Enrolled Nursing. This award is for an Enrolled Nurse currently employed in NSW who has demonstrated their commitment to nursing by: U Excelling within their scope of practise. U Pursuing professional, career and edu cational interests for all Enrolled Nurses. for nursing. U Showing a passion and U Acting as an advocate for, and support ing, Enrolled Nurses in NSW Health.

Rafflee 2013 Raffl

Typed applications (min 250 words) addressing any of the above criteria and outlining the qualiďŹ cations and employment history of the nominated Enrolled Nurse. The application should be signed by the applicant (either an RN or EN) and another (either RN or EN) who supports the application, and forwarded to: The Secretary ENPA PO Box 775, Kingswood NSW 2747

Before 30 June 2013. **Please ensure that full contact details are included.

Union Aid Abroad APHEDA

The overseas humanitarian aid agency of the ACTU

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A BLOG FOR AUSTRALIAN NURSES AND MIDWIVES Nurses & Midwives Online. On the frontline of Health Care and at the cutting edge. Sign up for the weekly email newsletter that alerts you to new posts. Nurse Uncut is also on Facebook: And on Twitter @nurseuncut

Irish nurses boycott low-pay new-grad scheme

New graduates in Ireland are boycotting a scheme that would pay them only 80% of the agreed salary rate.

Brisbane nurse speaks up against hospital cuts

Sarah Beaman spoke at a rally to protest major cuts to nursing staff at the Princess Alexandra Hospital, where she works in Brisbane.

Top nursing injuries (and how to avoid them)

Wrists, backs, ankles, burns, cuts, infections ...

Palliative care research

Annmarie Hosie, currently undertaking a PhD in delirium in palliative care patients, is wanting to carry out phone interviews with other palliative care nurses.

Compassion fatigue and the NHS

Britain’s NHS nurses are under attack for being “uncaring” – but Tara Nipe reckons they could simply be understaffed.

Safety in numbers

Victoria, New South Wales, the UK, California, Korea – successful campaigns for ratios around the world.

Nurses fyi – a digital magazine

Nurse Rich Williams wants to make history by publishing the first nursing magazine on an app for download to iPads.

Ratios save lives – and money too!

A compilation of research proves that nurse-patient ratios reduce complications, increase nurse satisfaction and make economic sense.


nsw nurses & midwives


36 | THE LAMP MARCH 2013

Follow us on Twitter >> NSWNurses & Midwives @nswnma Watch us on YouTube >> SupportNurses Connect with us on Facebook >> Aged Care Nurses >> Ratios put patient safety first >>

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“Love my work, hate my pay”

“I work for Mercy in Canberra, we need to do it here too!” Aged care nurses rallied against Mercy Aged Care in Young.

“I’m just sick of being abused all the time” A man who threw something at a Gold Coast nurse in triage was fined $1000 and given 80 hours community service. Training in Victoria Nurses in Victoria are being trained to do colonoscopies, cystoscopies, etc. What do you think?

“Good on you for charging this man. I have retired from nursing for the same reason. An assault by a patient was treated with the attitude of ‘It happens’. No more it doesn’t! I agree the assault of a health professional should carry the same penalty as assaulting a police officer and we have to be supported in charging these people so everyone will get the message that it’s not ok.” “It may seem that we just come to expect it in the job, but every nurse can only take so much. I totally understand her. Let’s hope it sets a precedent.” “I think it is time for a cold shower and meaningful debate about what is nursing. For years we cared, nurtured and observed holistically the person; then we had other professionals come in and take ‘bits’ off us as we were not ‘skilled enough’ to trim nails, do passive movements, to assess type of fluids to give ... Do nurses now want to do more while our core business is trivialised and thought less important? Not for me the extended role – no doubt will be graded to nurse practitioner level which to me has compartmentalised nursing into task experts, master of parts not the whole person.” “Problem with this is that there are barely enough nurses to do the nursing job that they are hired to do.” “Nurses are simply overworked and underpaid already.” “If nurses want to take on these skills, go to med school and become a doctor. Honestly I doubt very much that you would get an allowance that would equal what the Dr gets for doing the same procedure.” “Who does the laparotomy when they perforate the bowel!? And don’t try and tell me that it doesn’t happen cos it happens to the best colorectal surgeons and gastroenterologists.”

Ratios put patient safety first For the 2013 campaign we renamed our Facebook page: Ratios put patient safety first. New TV ads Our ad starring community nurse Mimi Chu was popular on YouTube.

“Brilliant campaign. I hope everyone signs up to support you. Every dollar spent on nurses returns huge dividends in public health. More power to you.” “Just a quick shout out to Mimi: as a first time mum, you were a great help and wealth of knowledge during the first couple of years of my son’s life – thank you. “Surely even the economic rationalists recognise a good return on investment when they see one! Investing money in more nurses is the cheapest possible way to improve community health on so many levels!” “It’s a great ad – well done and even better for using real nurses.”

The bush deserves better Our ad featuring an RN from Orange hit TV screens.

“Just because we live west of the mountains does not mean we deserve less …”

THE LAMP MARCH 2013 | 37

Recruit a new member and go in the draw for A Wonderful Holiday of a Lifetime Travel from Sydney to Perth in the classic Gold Service on the mighty Indian Pacific. The Indian Pacific is an epic journey that spans a continent. Over 3 days and 3 nights guests experience some of the most diverse scenery on earth – from the stunning Blue mountains with lush tree canopies and spectacular valley views, through the great Dividing Range, the salt lakes and sand dunes of South Australia and over the longest straight stretch of rail track in the world across the Nullarbor Plain.

Prize includes one way journey to Perth for two on the Indian Pacific, airfares for two from Perth to Sydney and five-night’s accommodation in a Novotel Perth Langley’s Superior King Room, including full buffet breakfast for two*.

Thomson Bay, Rottnest Island. Credit: Tourism Western Australia

Remember for every new member you recruit/have recruited from 30 June 2012 to 30 June 2013 means you will have your name submitted to the draw. RECRUITERS NOTE: Nurses and midwives can now join online! If you refer a new member to join online, make sure you ask them to put your name and workplace on the online application form. You will then be entitled to your vouchers and draw/s in the NSWNMA Recruitment Incentive Scheme.


This month’s articles come from the latest edition of the Australian Journal of Advanced Nursing ( Documentation in a PICU setting: Is a checklist tool effective? Kylie Boucher, Eliza Griffiths, Danielle Sargent, Nicole Mabotha, Pauline George, Dianne McKinley, Siriol Marks.

The introduction of a new checklist-style nursing documentation tool in the Paediatric Intensive Care Unit (PICU) at a major metropolitan paediatric hospital in Australia, provided an opportunity to assess the level of staff compliance with institutional documentation. PICUs provide services for children requiring specialised medical care for complex health conditions. These units offer a broad range of treatment types, requiring nursing staff to provide high level care across multiple specialised fields. As such, nursing duties within these units are challenging and complex. PICUs have been indicated as high risk areas where, due to the complex nature of the environment, errors can occur. In this setting, nursing documentation becomes an important element of patient care, allowing communication between care teams and across nursing shifts, providing a legal record of care administered, and acting as a tool to help manage patient care. Studies have linked the quality and effectiveness of documentation with a reduction in patient mismanagement, demonstrating that nursing documentation is a vital tool in reducing mortality rates and adverse patient events. Checklist documentation as a method for error reduction in nursing tasks has been investigated in the literature. Checklist tools allow duties to be systematically completed in highly complex and stressful environments. This audit was designed to generate outcome data regarding staff usage of the new checklist within a PICU environment. In particular, the study aimed to determine whether there were particular shifts in which compliance varied, and whether individual elements of the new form were associated with low levels of completion.

Research and evidence-based practice in a rural Victorian cohort Alison Koschel, Maddalena Cross, Helen Haines, Kaye Ervin, Debbie SkinnerLouis, Daniel Carbone.

The healthcare system is under ever-increasing pressure, from nurses and other healthcare practitioners, to continually change and adapt as a result of the amount of new knowledge generated and reported through research. In response to these expectations, evidence based practice (EBP) in nursing has evolved to encourage the reinforcement of interventions, new ideas in patient care, and enduring outcomes to benefit patients. The past three decades have showcased the importance of EBP within the nursing profession. A huge emphasis has been placed on EBP in the workforce and the concepts and ideas surrounding EBP have been introduced into the nursing curricular, emphasising a commitment to the cause. Specifically, knowledge translation and implementation research are emerging as important reference material from within the healthcare system. It has been suggested the discipline of nursing has fallen behind other health professionals and the discipline has been measured when considering research output and its translation into improved patient care. There is little evidence of the prevalence of EBP implementation and the supportive nature of organisations for EBP in the rural Australian setting. The aim of this paper was to identify the research capacity of organisations of health professionals in rural Victoria. Additionally this paper explored the value of research in organisations across rural Victoria.

How competency standards became the preferred national technology for classifying nursing performance in Australia Laurie Grealish

The emergence of national competency standards for registered and enrolled nurses in the late 20th century was the subject of intense debate circa 1990. Today, competence and competency standards are ubiquitous in nursing, so taken for granted that competence has become a natural way of conceptualising nursing performance. In a period of less than 20 years, the classification of nursing work, and therefore nurses, into categories has become de rigueur in education and regulation, as well as in workforce management. In this history of the ANRAC Competencies 1990, now known as the ANMC (2006) Competency Standards, the author aims to make visible the work of making the standards possible, by describing how the ANRAC Competencies came to be the preferred technology for classifying nursing performance in Australia.

Incidence of phlebitis in patients with peripheral intravenous catheters: The influence of some risk factors Anabela Salgueiro-Oliveira, Pedro Parreira, Pedro Veiga.

Today the insertion of peripheral intravenous catheters (PIVCs) is a common practice in hospitals, resulting in local or systemic complications. Phlebitis is the main local complication with incidence varying according to different settings. Phlebitis is an inflammation of a vein, with multiple causes: traumatic (e.g. catheter too wide for the vein); chemical (e.g. solution irritates the vein) and septic (e.g. inappropriate aseptic technique during catheter insertion). Incidence of local or bloodstream infections (BSIs) associated with PIVCs is usually low, but they produce considerable morbidity because of the frequency of catheter insertion. The most common route of infection for short-term catheters is the migration of skin organisms at the insertion site into the cutaneous catheter tract and along the external surface of the catheter, and the development of biofilms, leading to an evasion of host defence mechanisms and to a phenotypic resistance to antimicrobial agents. Over the past two decades, studies about phlebitis have divided risk factors into four main groups: patients’ characteristics; therapy administered; health professionals’ practices; and materials used. Other guidelines based on findings from scientific studies systemise a set of recommendations for health professionals on the prevention of PIVC-related complications. This study aimed to identify the incidence of phlebitis and its risk factors in patients with PIVCs.

THE LAMP MARCH 2013 | 39


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test your

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11 12 13 14









23 24




Across 1. Black tongue 8. Antibody (1.1) 10. The lowermost of the laryngeal cartilages (7.9) 11. A sequence 12. Grafted, inserted 14. To remove or destroy the myelin surrounding the axons of nerve cells 15. Cheek 16. An alloy of an element or metal with mercury 18. Transmited a disease to

20. The study of hereditary improvement of the human race by controlled selective breeding 23. Prefix meaning “mouth” 25. Pertaining to both ears 26. A foot covering 27. To cause to conceive

Down 1. Abnormal smallness of the feet 2. Smooth, glossy skin 3. Oil-resistant synthetic rubber 4. A phosphor used to intensify screens in radiology 5. Reduce ability to perform voluntary oral movement (4.7) 6. A product contains less than 0.5g saturated and trans-fat per serving (9.3.4) 7. Nongerminal or not germinating 9. To lose blood from blood vessels’ rupture 13. Protrusion of the heart through an opening in the diaphragm

17. Relating to genus 19. Windpipe 20. Cubitus 21. An organ that produces a secretion for use in or for elimination from the body 22. Round, spheric, or oval bacteriums 24. A fastener used to close off a small vessel

THE LAMP MARCH 2013 | 41

Do you know about the new regulations governing the transfer of United Kingdom Pensions? These new rules can potentially have a major affect on the retirement incomes of expatriate nurses now working in Australia! 5/6+/2/,16)06,43210/44#264#,#16 /21#)216,)6326-1,43#326(-3#0#26 '/-3,/*6&/41/316%/21#)261!/./6 ('&%$

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BOOK ME Nursing & Midwifery Research: Methods and Appraisal for EvidenceBased Practice (4th ed.) Zevia Schneider, Dean Whitehead, Geri LoBiondo-Wood and Judith Haber j Elsevier Australia j j RRP $94.95 j ISBN 9780729541374

Mastering Medical Terminology Australia and New Zealand Sue Walker, Maryann Wood and Jenny Nicol j Elsevier Health (available through Elsevier Australia) j RRP $95 j ISBN 9780729541114

This completely updated fourth edition of Nursing & Midwifery Research: Methods and Appraisal for Evidence-Based Practice, upholds the premise that knowledge about research process and design is mandatory in today’s health care arena, and that all nurses and midwives need to understand research findings and their implications for changing practice. This edition includes chapters that discuss ethical issues in Australia and New Zealand.

Mastering Medical Terminology Australia & New Zealand takes a modular approach to medical terminology, starting with the basics of word structure and the specifics of how medical terms are devised. This is followed by medical terminology specific to each body system, finishing with two areas not normally covered in medical terminology texts, “Alternative and Complimentary Therapies” and “Public Health, Epidemiological and Clinical Research Terms”. The textbook is accompanied by a self-help workbook and electronic support materials, as well as diagrams and illustrations that will help to enhance understanding of the text.

Rural Mental Health: Issues, Policies, and Best Practices

The Organ Donor Experience: Good Samaritans and the Meaning of Altruism.

Edited by K. Bryant Smalley, Jacob C. Warren and Jackson P. Rainer j Springer Publishing j j RRP $65 j ISBN 9780826107992 Rural Mental Health: Issues, Policies, and Best Practices addresses the needs of America’s most underserved areas for mental health services, and offers the most up-to-date, research-based information on policies and practice in rural and frontier populations. Renowned clinicians and researchers examine the complexities of improving mental health in rural practice and offer clear recommendations that can be adapted into current practice and training programs. They bring an insightful objective to factors that contribute to mental illness and prevent access to treatment areas. These include limited resources, reliance on urban models and assumptions, and pervasive misunderstanding of rural realities by policy makers. The text also addresses diversity issues in rural mental health services.

The Nurse Manager’s Guide to an Inter-Generational Workforce Bonnie Clipper j Sigma Theta Tau International j j RRP $29.95 j ISBN 9781937554781 The Nurse Manager’s Guide to an Inter-Generational Workforce provides strategies and tools to help coach and motivate nurse managers when it comes to communicating with their nurses to reduce conflict for each generational group of nurses. This book should be on the reading list for all nurse executives, nurse managers and those who recruit and manage todays health care workers.

Katrina A. Bramstedt and Rena Down j Rowman & Littlefield Publishers, Inc. j j RRP $34.95 j ISBN 9781442211155 The Organ Donor Experience: Good Samaritans and the Meaning of Altruism profiles donors who have offered their organs to strangers and aims to help readers understand the motivation for their donations. For the donor, altruism should always be the primary motivation, though other motivations often come into play. Often, there are also subconscious reasons for performing this act of kindness. The Organ Donor Experience gives living, anonymous, organ donors of kidneys, liver lobes, and lung lobes the opportunity to tell their stories as they understand them.

SPECIAL INTEREST A Vision for the Bush: The NSW Bush Nursing Association 1911-1974 Lynette Russell and Judith Cornell j Australian College of Nursing j j RRP $33 j ISBN 9781921375514 A Vision for the Bush: The NSW Bush Nursing Association 1911-1974 chronicles the history of the Association from the early 1900s to 1975, when the New South Wales government took over delivery of health care to the communities that had been part of the web of Bush Nursing Services. Both authors, clearly fascinated by the amount of material they had unearthed in the College of Nursing Archives, felt it was a story that needed to be told.

All books can be ordered through the publisher or your local bookshop. NSWNMA members can borrow the books featured here, and many more, from our Records and Information Centre (RIC). Contact Jeannette Bromfield or Cathy Matias 8595 2121 All reviews by NSWNMA RIC Coordinator/Librarian Jeannette Bromfield. Some books are reviewed using information supplied and have not been independently reviewed. THE LAMP MARCH 2013 | 43


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Order your NSWNMA campaign scrub uniforms for conference and rally times, and make an impression!


Over the past few months, NSWNMA and Total Image Group have been working together to create a new fit for purpose scrubs range. The new campaign uniform range endorses a modern appearance and offers both comfort and durable features, while still embracing NSWNMA image.

Sizes range from XS-5XL to ensure various body shapes and sizes are catered. Most importantly, the range has been designed to ensure a comfortable fit every time.

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The new range consists of a Unisex Scrub Top and Unisex Classic Pant. Both made from 65% polyester, 35% cotton. This fabric blend is durable and of superior quality. The scrub campaign uniform also has number of functional features, including jet pockets, pen partition, drawstring front on pants and brushed fabric coating for added comfort.











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Scrub top and pant are $20 each incl GST. You can place your order by the following methods: 2

Shop online, online, by registering as a user on on our tailored NSWNMA online store. 2 Browse through the customised catalogue, catalogue complete the order form and send back to Total Image by: email Fax: 9569 6200 or Post PO Box 199, Westgate NSW 2048 Total Image accepts credit card payment by Visa, MasterCard, and AMEX (3.5% surcharge on AMEX) or cheque/money order. Delivery by Australia Post within 10-14 working days and charged at $5 incl GST.

For more information please contact TTotal otal Image on (02) 9569 6233 or email

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movies of the month


A roller coaster ride of a film set in the southern French city of Antibes, writes Liz Lyons.

Rust and Bones is a story of a father, Ali, who has a five-yearold son, Sam, to look after, no job, no money, but luckily a sister who can help him raise the boy. Ali (Matthias Schoenaerts) finally gets a job as a bouncer at a nightclub. A strong muscular man, he comes to the rescue of Stefanie (Marion Cotillard) who is being heckled during a brawl, and then leaves her his phone number in case she gets into trouble again. When Stefanie has an accident and loses her legs, Ali enters her life and a relationship begins first with her rehabilitation at home and then as lovers. There are many twist and turns in this movie and also a dark side examining what goes on in the paid street fighting world. This film is raw; it has some unexpected moments and keeps you guessing to the end. The camera work is exceptional with the fading in and out of scenes a refreshing newness to filmmaking. The performances from the actors are first class. Marion Cotillard was nominated for Best Actress at both the Golden Globe Awards and the BAFTAs for this role, and handles the rehabilitation scenes with realism. Matthias Schoenaerts as Ali is also very watchable with his toughness, ego and physicality but also his gentleness. Top performances by all the actors in this film, in particular the young boy Armand Verdure, as Sam. Liz Lyons is a Life Member of the NSWNMA. in cinemas 28 march

MEMBERGIVEAWAY The Lamp has 15 in-season double passes to give away to Rust and Bones, thanks to hopscotch films. the first 15 members to email their name, membership number, address and telephone number to will win. 48 | THE LAMP MARCH 2013

MEA MAXIMA CULPA Mea Maxima Culpa: Silence in the House of God is a compelling documentary that explores why the Catholic Church’s hierarchy has stubbornly thwarted attempts to bring paedophile priests to account. Initially it focuses in detail on a school for deaf boys, in the American city of Milwaukee, where the charismatic priest, Father Lawrence Murphy, molested hundreds of children in the 1950s. Being deaf, the children were extra vulnerable, and often had limited ability to communicate their abuse. The children’s world of “silence” was a metaphor of the Church’s “silence” in the face of this man’s abuse, which spanned decades. To illustrate the disturbing horror of what the boys experienced, director Alex Gibney uses actors to reenact Father Murphy’s marauding presence at night in the dormitories. From historical footage of the school, and detailed interviews with the victims, now middle-aged men, Gibney shows a regular pattern of how such abuse still continues throughout the world. As adults the victims eventually reported the abuse but as was typical of the time, they were ignored or disbelieved. As to why this negligence continues, ex-Benedictine priest and now mental health counsellor Richard Sipe makes the telling observation that the inflated role of the priest as a stand-in for Christ in the sacraments makes him untouchable. As a mental health nurse and counsellor myself, I would like to have heard Sipe develop this theme, along with the broader themes of sexuality and celibacy. Gibney shows that the Catholic Church has

ignored reports of sexual abuse of children for at least 1700 years, according to ancient documents held in the Vatican. Gibney also looks at the difficulty lawyers face in dealing with the Vatican because of its status as a sovereign state, and at the reluctance of international leaders to attack Christendom’s largest denomination. This is a timely movie for Australians, given that a national commission into institutional responses to child sexual abuse is now being planned. It is also an important movie for nurses like me, who work for the Catholic Health Care “brand” and who experience a positive perspective of the church’s healing focus. Murray James is an RN in the Mood Disorders Unit at St John of God Health Services, Burwood. in cinemas 28 march

DVDGIVEAWAY The Intouchables broke box office records in France and across Europe and to celebrate the release of the DVD in Australia The Lamp has 5 copies to giveaway, thanks to Roadshow Entertainment. For your chance to win write your name, address and membership number on the back of an envelope and send to: The Intouchables DVD Competition, 50 O’Dea Ave Waterloo NSW 2017 ONLY ONE ENTRY PER MEMBER WILL BE ACCEPTED.


Previous films can be viewed on our we website bsite gallery.html gallery .html Authorised by B.Holmes, General Secretary Secretary,, NSW Nurses and Midwives’ Association


conferences, seminars, meetings NSW Social Media and Critical Care (SMACC) March 11-13 Sydney Conference and Entertainment Centre Council for Children’s Nurses NSW Biennial Conference: Winds of Change - Thinking into Action March 14-15 Waterview Conference Centre, Bicentennial Park Sydney Think arthritis and osteoporosis: a clinical update day March 16 Kolling Institute, RNSH Sydney Australian Orthopaedic Nurses’ Association Annual Conference 5 April,Novatel, Homebush 2nd International Natural Health Summit 3-5 May, Rosehill Racecourse 7th Australian Women’s Health Conference 7-10 May, Sofitel Sydney Wentworth; (02) 9254 5000 Australian Dermatology Nurses’ Association (ADNA) 12th National Conference May 18-19 SMC Conference Centre, 66 Goulburn St, Sydney Blacktown Mount Druitt Nursing/Midwifery Research festival May 22 , Blacktown RSL Caroline O’Donnell 0422 006 786 Caroline.O’Donnell@swahs.

2013 Transplant Nurses’ Association Conference 24-25 October, Sydney High Acuity Nursing Course 4-5 June, Newcastle Australian Nursing and Midwifery Conference 17-18 October, Newcastle Amy McIntosh 0423 497 038 Building Regional Australia Summit 9-11 April, Armidale

ACT Continence Management in the ACT 22 March Marilyn Woodcock (02) 87415699 Tackling Asthma in Australia/National Asthma Conference 2013 19-20 March, Canberra

INTERSTATE Australian Private Hospitals Assoc 32nd National Congress 3-5 March, Melbourne 12th National Rural Health Conference 7-10 April, Adelaide Infant GORD and its Complications 20 April 2013, Brisbane International Council of Nurses (ICN) 25th Quadrennial Congress 18-23 May, Melbourne Australian No 2 Bullying Conference 22-24 May, Surfers Paradise Cancer Nurses Society of Australia 16th Winter Congress 25-27 July, Brisbane

Crossword solution M I C R O P O D I A




50 | THE LAMP MARCH 2013






Nur Nursing sing P People eople 85 85+ +

14th International Mental Health Conference 2013 5-6 August , Surfers Paradise SMART STROKES 2013 - 9th Australasian Nursing & Allied Health Stroke Conference 22-23 August, Brisbane Stephanie Rogers smartstrokes@theassociationspecialists Scholarship applications due 25 March Australian College of Midwives 18th Biennial Conference 30 September-3 October, Hobart

OVERSEAS Creating Healthy Work Environments 12-14 April, Indianapolis, USA Honor Society of Nursing 2013 World Congress for Psychiatric Nurses 2-4 May , Winnipeg, Canada 2nd World Congress of Clinical Safety 12-13 September, Heidelberg, Germany 8th European Congress on Violence in Clinical Psychiatry 23-26 October, Ghent, Belgium

REUNIONS St Vincent’s Hospital Sydney January 1973 PTS reunion 16 March Julie Campbell (Coombs) 0405 737 361 RAHC March 1973 PTS reunion 17 March Bronwyn Exley Jenny Elliott Sherran Alexander (Peck) Allandale Hospital Cessnock 50th reunion 23 March, Tickets $45 Cessnock Supporter Club (02) 49 932655 Royal Melbourne Hospital (January 1973 PTS) 6 April Claire Jenkins (Furlong) 0420 810 544 May 1976 Blacktown District Hospital Reunion 6pm, 25 May Lily’s Restaurant, Seven Hills Karen Walker or Diane Shinnick via Facebook or Western Suburbs Hospital Graduate Nurses Reunion Lunch Saturday 25 May Ryde-Eastwood Leagues Club Robyn Daniel 9644 9692 Robyn Conliffe 9858 1102

diary dates is a free service. Please send details of your event by the 5th of each month, in the format used here – event, date, contact details, website if applicable. Email: Fax: 9550 3667 Post: 50 O’Dea Ave, Waterloo NSW 2017

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The Lamp March 2013  

In this issue: Strong support for PHS claim: members have endorsed the NSWNMA Public Health System (PHS) draft claim that aims to deliver a...

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