The Lamp July 2009

lamp the

magazine of the NSW Nurses’ Association

volume 66 no.6 July 2009

WE CAN’T REPLACE

SKILLED NURSES Print Post Approved: PP241437/00033

IN PUBLIC HOSPITALS

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2 THE LAMP JULY 2009

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ABOUT THE LAMP

C O N T E N T S

Contacts NSW NURSES’ ASSOCIATION For all membership enquiries and assistance, including Lamp subscriptions and change of address, contact our Sydney office.

SYDNEY OFFICE 43 Australia Street Camperdown NSW 2050 PO Box 40 Camperdown NSW 1450 (all correspondence) T 8595 1234 (metro) 1300 367 962 (non-metro) F 9550 3667 E gensec@nswnurses.asn.au W www.nswnurses.asn.au HUNTER OFFICE 120 Tudor Street Hamilton NSW 2303 ILLAWARRA OFFICE L1, 63 Market Street Wollongong NSW 2500

Cover story

lamp the

magazine of the NSW Nurses’ Association

volume 66 no.6 July 2009

We can’t replace skilled nurses in public hospitals 12 WE CAN’T REPLACE

SKILLED NURSES Print Post Approved: PP241437/00033

IN PUBLIC HOSPITALS

Cover From left: Lyn Cohen, NUM, and Maree Tohi, CNS, put a strong case for skilled nurses in public hospitals.

Photography by Fiora Sacco

News in brief 8 8 8 8 9 9 9 10 10 10 11 11

Community coalition starts to build Ambassadors for mental health nursing appointed More states hand IR power to Canberra Strawberry fields Nurses get extra emergency duties One Car Less program New packaged hospital meals cause for concern Private health insurers attack Obama US nurses demand public healthcare Nursing the most honest profession Call for more GP nurse training The adverse health affects of inequality

NSWNA education program

Occupational health and safety 34 Protection from toxic drugs

NSWNA matters 36 NSWNA branch news

Lifestyle 38 Movie reviews

Obituaries 40 Jacquie Hart: fighter for rights at work 41 Patricia Shirley Ellercamp: inspiring teacher, compassionate nurse

Regular columns

11 What’s on

5

Professional issues

6 33 42 45 47 48

20 New horizons for nurses in primary health care 30 The art of caring

Aged care 24 Breakthrough on new ACS agreement 27 RNs warned on nursing home absence

Industrial issues 28 Keeping your job after a workplace injury 29 Community home nurses ripped off

Agenda

Editorial

by Brett Holmes Your letters to The Lamp Ask Judith Books Nursing online Our nursing crossword Diary dates

Competition 17 Win an all-inclusive getaway to Solar Springs Health Retreat

Special offers 39 Win 100 double passes to the preview of My Friends, My Love, 25 double passes to Chéri and 30 double passes to The Fox and the Child

32 State Budget 2009

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34

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NSWNA COMMUNICATIONS MANAGER Noel Hester T 8595 2153 NSWNA COMMUNICATIONS ASSISTANT Russell Burns T 8595 1219 For all Lamp editorial enquiries, letters and diary dates: Editorial Enquiries T 8595 1234 E lamp@nswnurses.asn.au M PO Box 40 Camperdown NSW 1450 THE LAMP PRODUCED BY Lodestar Communications T 9560 1223 PRESS RELEASES Send your press releases to: T 9550 3667 E gensec@nswnurses.asn.au THE LAMP EDITORIAL COMMITTEE Brett Holmes, NSWNA General Secretary Judith Kiejda, NSWNA Assistant General Secretary Coral Levett, NSWNA President John Lyons, Baradine MPS Mark Kearin, Blacktown/ Mt Druitt Hospital Roz Norman, Tamworth Base Hospital Stephen Metcalfe, Lismore Base Hospital Peg Hibbert, Hornsby & Ku-Ring-Gai Hospital Michelle Cashman, Long Jetty Continuing Care ADVERTISING Patricia Purcell T 8595 2139 or 0416 259 845 F 9550 3667 E ppurcell@nswnurses.asn.au RECORDS AND INFORMATION CENTRE – LIBRARY To find old articles in The Lamp, or to borrow from the NSWNA library’s nursing and health collection, contact: Jeannette Bromfield, RIC Coordinator T 8595 2175 E gensec@nswnurses.asn.au THE LAMP ISSN: 0047-3936 General disclaimer The Lamp is the official magazine of the NSWNA. Views expressed in articles are contributors’ own and not necessarily those of the NSWNA. 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 NSWNA takes no responsibility for the advertising appearing herein and it does not necessarily endorse any products advertised.

Privacy Privacy statement: The NSWNA 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 NSWNA office. If you are still not satisfied that your privacy is being maintained you can contact the Privacy Commission.

Subscriptions Free to all Association members. Professional members can subscribe to the magazine at a reduced rate of $50.

Individuals $70, Institutions $106, Overseas $116.

ProfessionalDay

FRIDAY 31 JULY 2009, AUSTRALIAN JOCKEY CLUB, RANDWICK, SYDNEY. SPEAKERS ASSOCIATE PROFESSOR SABINA KNIGHT for Remote THIS YEAR THE NSWNA PROFESSIONAL DAY WILL Centre EXPLORE THE Health CONCEPT OF CARING ‘Health reform – the consequences for care’ FROM A RANGE OF PERSPECTIVES , INCLUDING ESSENTIALS OF CARE , THE ROLE OF CARERS , LEGAL ISSUES AND MIDWIFERY , ALLOWING PARTICIPANTS TO REFLECT ESSENTIAL ADJUNCT PROFESSOR DEBRA THOMS Chief Nursing and Midwifery Officer,ON NSWTHIS Health ASPECT OF THE NURSING AND MIDWIFERY ROLE .

‘Essentials of Care’ ASSOCIATE PROFESSOR HANNAH DAHLEN Australian College of Midwives ‘Because we care, we dare’ MARGARET MORRIS, NURSE PRACTITIONER Dialysis, Anaemia Coordinator, Dialysis Unit St Vincent’s Hospital ‘Developing a nurse practitioner model for maintenance dialysis: the St. Vincent’s Health Melbourne experience’ THE HONOURABLE PATRICIA STAUNTON, AM ‘A legal perspective on care’ SUE PIETERS-HAWKE ‘A carer’s perspective’ JANINE SHEPHERD, AM ‘Never tell me never’ CONTACT CAROLYN KULLING ON 02 8595 2181 (METRO) OR 1300 367 962 (REGIONAL)

4 THE LAMP JULY 2009

AUTHORISED BY B HOLMES, NSWNA

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E D I T O R I A L

BY BRETT HOLMES GENERAL SECRETARY

There’s no substitute for a qualified nurse g NSW Health is exploring ways of introducing more third level health workers into our public hospital system. We need to be on our guard.

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he most recent annual Roy Morgan professions survey showed nurses are regarded as the most ‘ethical and honest’ of all professions. This is the fifteenth year in a row that nurses have headed the survey.

It confirms that the Australian public continues to appreciate the benefits that nurses bring to Australia’s health.

Our own research shows that while the public has the deepest respect and admiration for the care nurses bring to their job, they don’t always have an understanding of the high level of education, skill and professionalism of the nursing role. The goal of our current advertising campaign is to make people more aware of this.

This is important because the status of our profession is facing serious and immediate challenges and we need the community at our side.

It is often overlooked that NSW has a world-class health system. There is relentless media scrutiny of the public health system, more often than not conducted in a negative light. Breakdowns in the system and crises are always in the spotlight. But an overwhelming majority of the public, as our research also tells us, has positive experiences when they come into contact with our public hospitals.

The Garling inquiry highlighted the challenges before the health system: a sudden and dramatic increase in the number of people using it, an ageing demographic among nurses, and poor workforce planning.

Numerous university studies clearly indicate that quality health outcomes and better patient safety come from high numbers of RNs. The dilemma before us is how to find

the right skill mix in our public hospitals, with sufficient numbers of RNs to meet the challenges and maintain that worldclass system.

At least with an AiN the role is carried out within a nursing team with training and supervision by an experienced nurse.

The NSWNA is conscious there has to be innovative thinking to achieve this but we are also adamant that patient safety and quality health outcomes are paramount.

The Health Department has flagged an intention to introduce an unlicensed generic health worker into the public health system (see story p12). This is a development for which we need to be on guard. Our experience in aged care has shown us that the introduction of an unlicensed worker without mechanisms

of accountability can lead to these workers being misused in roles outside nursing care. They can end up doing gardening or cooking as well as care work. Effectively they are jacks-of-all-trades and masters of none. This is not a model we want in public hospitals or any health setting, for that matter.

There is an important place for third level health workers but there needs to be accountability in the role and appropriate numbers employed.

At least with an AiN the role is carried out within a nursing team with training and supervision by an experienced nurse. By assisting and supporting the nursing team, an AiN’s contribution is important and valuable. But it is a role that needs to be clearly defined and tightly supervised by an RN in a clinical leadership role.

To be effective within the nursing team, AiNs need access to training delivered by quality providers. This gives them a taste of working in the nursing profession and provides them with a career pathway into enrolled nursing or registered nursing.

There is a place for well trained AiNs with a clearly defined role. How they are deployed within wards, and in what numbers, needs to be left to the professional judgement of the NUM. It would be all too easy, when confronting the challenges articulated by Garling, to see the introduction of more third level workers – whether AiNs or generic care workers – as a simple, cheap fix to the workforce problems in public health.

We believe that would be a mistake with adverse impacts on patient safety.

Experienced nurses are the key to high quality patient care and when looked at in a rational way, the most cost effective way of delivering that care.n THE LAMP JULY 2009 5

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L E T T E R S

LETTER of the month

Melissa Lintott (left) and Robyn Keath

Calvary Mater downplays nurse shortages The Calvary Mater Newcastle Intensive Care Unit (ICU) has a nursing shortage of over seven full-time-equivalent (FTE) registered nurses at present.

The ICU is funded for five intensive care beds and one high dependency bed. The intensive care also provides the nursing and medical staff for the Medical Emergency Team (MET).

The Nursing Unit Manager frequently works in charge because there just isn’t the staff. The agreed supernumerary in charge position also continues to take on a clinical load because there just isn’t the staff.

The Clinical Nurse Educators regularly provide meal break relief, otherwise staff would not get a meal break. They are also asked to take on a clinical load at times because ICU does not have enough staff to maintain patient care in the unit.

The converted additional overtime 1.7 FTE management agreed to has made no difference to the overtime.

It is unacceptable that nursing staff do excessive amounts of overtime because of inadequate staffing. One full-time staff member recently did 42 hours/fortnight overtime because there was just not the staff and it was easier to do the overtime herself rather than beg others. The nurses get tired,

LETTER of the month The letter judged the best each month will be awarded a $50 DJ’s voucher, courtesy Medicraft Hill-Rom, for details on the range of hospital beds, trolleys, mattress & care solutions please call (02) 9569 0255 or visit www. medicrafthill-rom.com

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6 THE LAMP JULY 2009

they have families and they have a life outside work but they do the overtime because they have a commitment to their patients.

The General Manager in the Media Unit said the staffing guidelines are ‘simply guidelines’. The guidelines referred to come from the Department of Health Critical Care Service Planning. Working towards them is not good enough. We should be meeting them. The General Manager also talks about risk assessment management processes. The risk assessments showed that the ICU has a nurse shortage that compromises both the safety of the patient and the nurse.

The risk management process seems to be just more overtime.

The ICU Nurses at Calvary Mater are passionate about their commitment to provide the best quality care they possibly can in the safest way to the Hunter community.

They do not want to see patients transferred elsewhere in the state because they do not have the nursing staff to staff the bed. There are two issues with transfers: an ICU bed may be available but there is no staff; or there are just not enough beds.

The nursing staff does not believe they have been unreasonable in taking this matter further via the reasonable workloads committee and after failing that to the Industrial Relations Commission. The conciliation process identified that the Calvary Mater has no funding to increase staff and that there would be no funding forthcoming from Hunter New England AHS. The NSW Nurses’ Association is now in the process of proceeding to arbitration on behalf of the Branch.

It’s not just a shortage of nurses but a shortfall for the Hunter yet again.

Robyn Keath and Melissa Lintott, Calvary Mater Newcastle Robyn Keath and Melissa Lintott won the prize for this month’s letter of the month, a $50 David Jones voucher.

Kevin O’Neill

Addressing risks for communitybased mental health nurses I was delighted to see that Melbourne’s St Vincent’s Hospital has considered the risks experienced by their community-based mental health nurse equal to, or sometimes even greater than, those faced by their in-patient unit colleagues. I think expenditure of $9,000 to kit out home visiting staff with the ‘panic button phones’ (p8, The Lamp, May issue) shows that at least St Vincent’s is taking their risk management seriously.

About three years ago I worked with a supplier of duress alarms to mental health in-patient units in Sydney South West AHS (SSWAHS) to develop a mobile duress unit similar to the principle now adopted by the St Vincent’s Mental Health Services. The device the manufacturer came up with consisted of a portable, car-based unit containing a GPS unit and a mobile phone that acted as a transmitter.

The mental health worker carried the standard duress alarm commonly used within in-patient units. When activated, it sent a duress signal to the transmitter located in the work vehicle, which in turn sent the signal as a recorded message to a receiving mobile phone and computer at the worker’s home base. The GPS allowed the placement of the work vehicle to be identified and sent to the receiving mobile phone along with the emergency message.

The beauty of this system was the alarm could be raised silently by the push of a button, and if the staff member was knocked down, or the unit was pulled from the worker’s belt or clothing, it would be activated automatically.

To test the unit in our rural area, I spent the better part of a Sunday travelling all over the Southern Highlands activating the unit for an assessment of its effectiveness.

Wherever there was a signal from a mobile phone tower, the GPS report and an emergency message was received.

When I asked for funding for a trial project of the duress alarm it was refused

by SSWAHS. I was informed that the Area opposed the trial on the basis that if it worked, all community-based nurses would want them. It seems that Melbourne, at least, values their responsibility to provide a safe work environment with something more practical than just words in a policy.

Kevin O’Neill, RN, Wingecarribee Community Health

Got something to say?

Send your letters to: Editorial Enquiries email lamp@nswnurses.asn.au fax 9550 3667 mail PO Box 40 Camperdown NSW 1450 Please include a photograph along with your name, address, phone and membership number. Letters may be edited for clarity and space.

Kerry Troy

Accommodation for nursing students We are all keen to help our students in the ward area. We want them to see and experience as many situations as possible so they feel confident when they graduate.

As a midwife and mum of a second year student, who is doing her training through CSU Bathurst, it would be great if we extended that care to supplying help outside the hospital with accommodation.

It is hard for students to leave their local area to take up placements at a hospital and then to find and pay for accommodation.

I am sure there would be nursing staff who would be willing to billet students.

This would give them an insight into a working nurse’s life and may also give them the opportunity to debrief after a day’s work. I can remember going back to the nurse’s home after a shift and sharing the day’s events with fellow nurses.

Having accommodation would assist both the city and country kids, as it would then increase the number of hospitals they would be comfortable to list as possible sites to do placements.

I know my daughter is restricted in her area to list places where we know someone for accommodation.

It would not be hard to have a list of possible billets in the education departments of the hospital for the students to access and then arrange billets themselves so that no one person was burdened with the job.

Kerry Troy, RM, Shoalhaven District Memorial Hospital

Wendy Watson

Global economic downturn erodes job security As nurses, we have always felt job security in our working environments with a number of avenues and opportunities to pursue our career aspirations. We have been reminded for a number of years of the

chronic shortage of nurses and have always believed we would be needed. We have sheltered in the ethos that we are a caring profession and, therefore, would be cared for ourselves. The global economic plight has eroded this security with few positions available in the public health care sector and even less in the private sector. On a smaller scale, practice nurses are losing their security. As nurses resign, their positions are left vacant or made redundant because their workplaces are undergoing ‘restructuring’.

I and many of my colleagues are being confronted with radical changes to our working occupancies, which, as for anyone who has been confronted with loss of income and working identity, will have far-reaching consequences not only for us but for the people in our lives who depend on us as providers.

I would like to take the opportunity to thank the NSWNA for their representation and negotiation on our behalf and in particular, our delegates, Fiona Farmer and Lee-Ann Heta, who have extended themselves selflessly in facilitating the negotiation process for the best outcomes for our futures. Negotiation continues and the outcome is probably not going to be favourable but without these people and the Association behind us we would be in a much worse position. Thank you, Fiona, Lee-Ann and the NSWNA. Wendy Watson, NE, College of Nursing Branch (Burwood)

Peter Wordon

Lions Nurses Scholarship continues to aid professional development My dear friends in the nursing profession, the time has come for me to hang up my hat. After two major operations in Westmead Hospital, serving as a Director of the Foundation was my way of repaying nurses for the untiring care you gave me after my operations and so, 12 years ago, I became a Director of the Edith Cavell Trust.

At that time our scholarship funding was based on a small investment, ($300,000), meaning the interest received was not very great and we were relying heavily on the Lions of District N5 for donations that could only be invested.

Three years ago I was elected and honoured to become the Foundation’s Chairman. Realising a lot of our funding was being presented in other districts that have NSW Lions Clubs, I decided a lot of changes would have to be tried. If they didn’t work, we could think of some other way to raise funds. It was agreed to produce our own ‘Commitment to Service’ award. These became available with a donation of $500. To date, 28 have been purchased. Donations began to come in and our investment reached $500,000.

The Foundation now has liaison officers in three other districts – only three more to ensnare and NSW will be finally covered. As a result, we then took the presentations to the nurses at Club Dinner meetings, thus giving the Lion members an idea where their donation money was going (more donations, please).

Although I still have 18 months to run, I feel it is time for a new and much younger director to take the chair. I am hoping my successor will continue the development I have been instrumental in creating. After 41 years in Lions, I am beginning to get tired, and I’m gradually losing the zest I once had.

Let me say I leave knowing the Foundation’s investment has been doubled, and in good financial times our disbursement of funding was very good.

My goal when I took the chair was to reach that $750,000 mark, and finally one million. With luck, my successor will be able to achieve this.

It is with sincere thanks I have been able to repay your kindnesses in this way.

I am hoping you continue to progress professionally with the aid of the Foundations Scholarships.

Peter Wordon, Retiring Chairman, NSWNA Lions Nurses Scholarship Foundation Ltd.

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THE LAMP JULY 2009 7

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N E W S I INN BBRRI IEEFF

COMMUNITY

COALITION STARTS TO BUILD he NSW Nurses’ Association has begun training its officials in community organising skills in preparation for work with a new coalition of community groups that aims to improve the quality of life in Sydney.

The Sydney Alliance so far comprises more than 20 community, religious and union organisations including the NSWNA. The aim is to build a broad coalition of diverse organisations that can campaign together for measures that will help create a fair and just Sydney, said NSWNA Acting General Secretary Judith Kiejda.

‘The Alliance is a non-party political organisation designed to achieve social change while building peace in our communities,’ she said.

Members include the Uniting Church NSW Synod, the Arab Council of Australia, the Jewish Board of Deputies, the Parramatta Diocese of the Catholic Church, Asian Women at Work and several unions.

The Alliance is running training courses for affiliates in preparation for meetings to determine specific campaign goals later this year.

The Sydney Alliance is modelled on similar organisations overseas that have successfully campaigned for a living wage (London), expanded public transport (Baltimore), or new apprenticeship programs for local youth (Seattle). There are similar coalitions in Canada, Germany and the United States.

‘The Alliance will give the NSWNA the opportunity to collaborate with organisations we have not worked with closely in the past,’ Judith said.

‘If we can work together successfully we can be a strong force for social change that will benefit nurses and their families in areas such as a better health system and quality aged care.’

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8 THE LAMP JULY 2009

Ambassadors for mental health nursing appointed Mental health nurses with diverse clinical experience and inspiring stories to tell have been appointed as ambassadors in an innovative program to drive recruitment and retention.

The ambassadors will work with the Australian College of Mental Health Nurses in all states and territories over the next 12 months to promote the profession to secondary students, undergraduate nursing students and other tertiary students with an interest in mental health.

‘Our own research indicates that young people considering a career in the health sector are often unaware of mental health nursing as an option within nursing. There is no-one better equipped to inform and inspire others about the many clinical settings, areas of specialisation, skills, opportunities and rewards of mental health nursing than mental health nurses themselves.

Our ambassadors are keen to address some of the myths and misperceptions that exist in the community about mental health nursing,’ said College Executive Officer Kim Ryan.

More states hand IR power to Canberra Australia has moved closer to a national industrial relations system, with two more states handing over some of their IR powers to the Federal Government.

Tasmania and South Australia joined Victoria in referring their authority over industrial relations in the private sector to Canberra last month.

All three states have kept their powers to regulate the public sector and local government.

NSW and Queensland are still in negotiation with the Federal Government while Western Australia is considered unlikely to refer its powers, and will conduct its own review of state workplace laws.

Before the 2007 federal election, Labor promised to negotiate with the states to replace the six systems regulating private sector employment around the nation with a single system. Federal Labor claims

a uniform system will reduce costs and confusion for business and employees.

South Australia Unions Secretary Janet Giles said the transfer of private sector powers with the state retaining its authority over the public sector was exactly what unions asked for.

Australia has moved closer to a national industrial relations system.

SA Industrial Relations Minister Paul Caica said it was appropriate for the state to continue to be responsible for work arrangements for its own employees.

‘In future, agreement could be reached that it is appropriate for the public sector to be part of a national system, but at this point in time we believe it’s appropriate for the public sector to stay within the state jurisdiction,’ he said.

Strawberry fields Still pining for WorkChoices, some former Howard Government stalwarts are struggling to get to grips with Labor’s new industrial relations system.

National Party leader National Party Warren Truss leader Warren Truss, in particular, appears flummoxed by such novel IR concepts as penalty rates.

Mr Truss got to his feet in Federal Parliament on 16 June to ask the Minister for Employment and Workplace Relations, Julia Gillard: ‘I refer the Minister again to her award modernisation process that will more than double wages paid to strawberry pickers on Sundays and public holidays. Does the minister have a plan to ensure that strawberries only ripen on weekdays or does the minister expect consumers to pay double for strawberries picked on holidays?’

It’s unlikely farmers will try to sell Sunday-picked strawberrries at twice the price of those picked the day before and the day after.

Instead, they may respond to Labor’s monstrous imposition of penalty rates by doing what most businesses already do – averaging out any extra cost.

NURSES GET EXTRA EMERGENCY

DUTIES

evin Rudd has announced that people arriving at hospital emergency departments with minor ailments will soon be treated by a team of nurses, with the development of Australia’s first nurse-led emergency walk-in centre to commence at Canberra Hospital in July.

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Federal Health Minister Nicola Roxon said most people appreciated the value of highly-skilled nurses to the stressed public health system.

The $10 million centre, scheduled to open its doors in June 2010, is designed to take the pressure off emergency department staff and allow them to focus on more serious and life-threatening medical emergencies.

The walk-in centre will operate 16 hours a day, seven days a week, and is the first of many such centres planned for development around Australia. A team of highly-skilled nurse practitioners will run the centre, providing taxpayer-subsidised diagnostic tests and prescription medicines. However, Rudd emphasised that the centre will be located near the emergency department, in case a patient needs more acute medical care or assessment.

In response to the Australian Medical Association’s concerns about patients being assessed in the absence of doctors, Federal Health Minister Nicola Roxon said most people appreciated the value of highly-skilled nurses to the stressed public health system.

‘We believe in Australia we have highly-skilled nurses, as we have highly-skilled doctors and specialists, and they too should be able to use their skills to their maximum ability,’ Minister Roxon said.

A show of hands by NCAHS staff using active transport.

One Car Less program The North Coast Area Health Service (NCAHS) has officially launched a new occupational health and safety program called ‘One Car Less’.

The program is a health initiative that aims to encourage staff to leave their cars at home at least one day per week and find other ways to commute, such as walking, cycling, taking public transport or carpooling, to increase levels of exercise and reduce greenhouse gas emissions.

‘We developed One Car Less after finding out the majority of our staff drive solo to work at least three or more days per week and yet 19% live within five kilometres of their workplace. There was also expressed interest in finding alternative ways of travelling to and from work,’ NCAHS Health Promotion, Nutrition and Physical Activity Coordinator Jillian Adams told the Bellingen Courier Sun. North Coast nurses hope to be role models in the community for walking, cycling and car pooling, and to create a demand for affordable and accessible public transport. NSWNA applauds the One Car Less program and encourages its branches in other Area Health Services to lobby for similar programs at their own workplaces.

New packaged hospital meals cause for concern State Health Minister John Della Bosca announced last month that all food served in public hospitals will come from one centralised production centre and be packaged and frozen before being delivered to hospitals.

The announcement follows findings in The Garling Report that one in four patients becomes malnourished during

their hospital stay due to poor meal presentation. Garling also found that many of the 22-million hospital meals served in NSW each year are unappealing, difficult to open and lacking in adequate nutrition.

John Della Bosca told ABC radio that nurses and midwives would be put in charge of nutritional intake and monitoring of patients at meal times, helping them to open packets of food and use eating utensils.

‘Our nurses and midwives are already over worked.They do see nutrition as a critical issue for patient care but they don’t have the time to sit with every patient.’

NSWNA General Secretary Brett Holmes said the association had not been informed about the change. ‘Our nurses and midwives are already over worked.

They do see nutrition as a critical issue for patient care but they don’t have the time to sit with every patient.’

Healthier and more appetising hospital food is a step forward, but the move to pack all meals in airline-style plastic trays is a big step backwards given that the Garling Report found 70% of elderly and very sick patients are not able to open sealed meals without help. More packaging and transportation is also less environmentally sustainable.

The NSWNA is calling for more clerical staff to be employed in wards to help free up nurses at meal times, but even with the 500 new administrative workers the NSW Government has promised, the expectation that nurses will find time to monitor the meals of all patients seems unrealistic.

THE LAMP JULY 2009 9

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On the ‘RN National Day of Action’ hundreds of nurses from hospitals all over the USA converged outside the Capitol building in Washington DC to demand a public healthcare system that covers all Americans.

N E W S I INN BBRRI IEEFF

PRIVATE HEALTH

INSURERS

ATTACK OBAMA resident Barack Obama says that one of his administration’s top priorities is providing affordable healthcare for all Americans. He is in the process of building a national healthcare system and hopes to have federal legislation passed later in the year.

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If Obama’s legislation is successfully passed, private insurers would have to lower their rates and improve their quality of care in order to compete with the public system.

However, private health insurance giants, including Blue Cross Blue Shield, are mounting a massive scare campaign arguing that Obama’s plans for a more equitable healthcare system would adversely affect patient care and hurt the company’s bottom lines.

‘We’re concerned about what it means, as to how it would impact on our business,’ said spokesman for Blue Cross Blue Shield, Lew Borman.

‘How level would the playing field be?’

If Obama’s legislation is successfully passed, private insurers would have to lower their rates and improve their quality of care in order to compete with the public system, consequently lowering America’s massive annual health bill.

Furthermore, tax payers would no longer be subsidising CEO salaries, or stockholder profits. No wonder the insurance giants are scared.

10 THE LAMP JULY 2009

US nurses demand public healthcare Given the current debates in Australia over private healthcare, and the Liberal Party’s historic and ongoing preference for replacing Medicare with a model of universal private healthcare, Australian nurses may take interest in the stance of their American colleagues on the ‘RN National Day of Action’ on 13 May. Hundreds of nurses from hospitals all over the USA converged outside the Capitol building in Washington DC to demand a public healthcare system that covers all Americans.

‘Since when is healthcare a product? ...We have to take the profit out of healthcare.’

Under banners of ‘Guaranteed Healthcare’ and ‘Stop the Insurance Industry Bailout’, and chants of ‘We are the Nurses, the Mighty, Mighty Nurses’, RNs demanded healthcare for all US citizens.

Nearly 50 million Americans are not covered by any healthcare and, although the US spends more per person on healthcare than any other country, the World Health Organisation ranks the US number 72 in the world in terms of overall healthcare.

Actor Mike Farrell, most famous for

his role in MASH, applauded nurses for their role on the frontline of a healthcare system that he said ‘leaves millions to suffer and die because they don’t fit in the margins of profit’.

‘Since when is healthcare a product?’ he said, and urged nurses to keep lobbying for change. ‘We have to take the profit out of healthcare,’ he said.

The RN National Day of Action was organised by nursing associations from many American States, as well as the National Nurses Organizing Committee.

Nursing the most honest profession Nursing has emerged as the top profession for honesty and ethics, according to a recent Roy Morgan poll measuring public perceptions of ethics and honesty for various professions.

Nurses have come out tops for the 15th year in a row, with 89% of Australians aged 14 and over rating nursing as the most ethical and honest profession.

Honest nurses are closely followed by pharmacists (84%) and doctors (82%).

The lowest professions are car salesmen on 3% (for 20 years running), advertising people (6%), newspaper journalists (9%) and estate agents (10%).

Comparing 2009 results to those of 2008 shows that the image of most professions declined in 2009. Of 29 professions surveyed in both years, 23 saw declines in 2009.

Call for more GP nurse training

The adverse health affects of inequality

Nurses should play a bigger role in GP surgeries but training in Australia is skewed towards hospital or acute care work, says an Australian National University researcher.

Associate Professor Rhian Parker, from the Australian Primary Health Care Research Institute, is co-author of a study on practice nursing published last month in the journal BMC Nursing (www. biomedcentral.com/1472-6955/8/5).

Professor Parker said Australian nurses are often not educated in their pre registration years to meet the needs of primary care.

Epidemiologists Kate Pickett and Richard Wilkinson have written a book, The Spirit Level: Why More Equal Societies Almost Always Do Better, which shows that advanced economies with large income disparities are more likely to suffer a wide range of social ills than more equal societies.

In Great Britain, The Spirit Level has been referred to in debates about fairness in the House of Commons, House of Lords and the Scottish Assembly, and the Archbishop of Canterbury gave a copy to Kevin Rudd when he visited England earlier this year.

Research in the book shows that once societies pass a basic wealth threshold, equality of income becomes more important for social outcomes than the total wealth of the society, or even the average wealth of its citizens. That means there is more benefit in levelling out the wealth then in increasing it, which raises serious questions about the endless drive for economic growth.

Australia needs to develop national training standards and accreditation for practice nursing.

‘Careers in primary care may not be as attractive to nursing graduates as high-tech settings such as intensive or acute care. Yet, it is in primary care that increasingly complex health problems are managed,’ she said.

She said Australia needed to develop national training standards and accreditation for practice nursing.

‘Whilst substantial funding has been made available for the training of practice nurses in specified clinical skills, there are no outcome frameworks for that education, and it is very limited in its scope.

‘Moreover, current pre-registration education in Australia does not prepare nurses for primary care while postgraduate education is piecemeal, not comprehensive nor consistent across the country and also lacks quality assured outcome evaluation.’

Professor Parker said Britain, where practice nurses were more common, had developed career paths for nurses to work in surgeries.

‘The experience of the UK and NZ is that career frameworks are necessary … to attract nurses into primary care and retain the services of nurses who are already working in the sector as well as acknowledging the accumulation of skills and knowledge that comes with experience and education.’

More equal societies outperformed the less equal on almost all indicators.

More equal societies, led by Japan, the Nordic countries, Belgium, Austria and Germany, outperformed the less equal on almost all indicators, including mental illness, obesity, cardiovascular disease, unwillingness to engage with education, misuse of illegal and prescription drugs, teenage pregnancy, lack of social mobility, neglect of child welfare, and violence ranging from school bullying to murder. For example, in more equal Japan and Spain, only one in 10 people report a mental health problem each year, compared with one in five in Australia, Britain, New Zealand or Canada and one in four in the US. Despite its claim to be the ‘fair go’ country, Australia ranked badly overall.

Only Britain, Singapore, the USA and Portugal are less equal.

s Basic Computer Skills For Nurses 4 August, Concord Hospital, 1 day 27 October, Concord Hospital, 1 day Seminar is suitable for all nurses.

Members $85 • Non-members $170 s Legal and Professional Issues for Nurses 17 August, Camperdown, ½ day 2 October, Dubbo, ½ day 30 October, Batemans Bay, ½ day 6 November, Westmead, ½ day Topics covered include the Nurses and Midwives Act 1991, potential liability, documentation, role of disciplinary tribunals including the NMB, writing statements.

Members $39 • Non-members $85 s Basic Foot Care for RNs & ENs 17 & 18 August, Coraki, 2 days 15 & 16 October, Camperdown, 2 days A VETAB-accredited course that aims to provide nurses with the competence to provide basic foot care.

Members $203 • Non-members $350 s Mental Health Nurses Forum 21 August, Rydges Camperdown, 1 day Seminar is suitable for all nurses.

Members $30 • Non-members $50 s Basic Foot Care for AiNs 9 September, Grafton This course aims to provide AiNs with the competence to provide basic foot care.

Members $85 • Non-members $150 s Policy & Guideline Writing 11 September, Camperdown, 1 day Seminar is suitable for all nurses.

Members $85 • Non-members $170 s Managing Appropriate Workplace Behaviour 19 October, Rydges Camperdown This seminar is specially designed for managers and compliments the Appropriate Workplace Behaviour seminar.

Members $85 • Non-members $170 s Drug & Alcohol Forum 23 October, Rydges Camperdown, 1 day Seminar is suitable for all nurses.

Members $30 • Non-members $50

TO REGISTER or for more information go to www.nswnurses.asn.au or11ring THE LAMP JULY 2009 Carolyn Kulling on 1300 367 962

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C O V E R S T O R Y

We can’t replace skilled g The increased use of AiNs and other third level workers across the nursing sectors poses challenges for the profession. On the one hand a wealth of research shows the centrality of RNs in delivering high quality patient care; on the other innovative solutions are needed to relieve overwhelming workloads.

The Lamp looks at the issues.

NSW HEALTH INTRODUCES UNLICENSED WORKERS Unlicensed workers need to be supervised by qualified nurses for patient safety, says NSWNA.

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SW Health has confirmed it is working with the Area Health Services to trial new unlicensed classifications.

The NSWNA has clearly signalled its concerns to NSW Health that staff covered by these classifications undertaking invasive procedures or observations, without the in-depth understanding of the physiology behind them, could have a serious adverse impact on patient care.

NSWNA General Secretary Brett Holmes says the introduction of this new category of worker into the acute sector must be monitored by nurses with the utmost vigilance.

‘The introduction of this sort of employee into the acute sector in other countries as well as their use in the aged 12 THE LAMP JULY 2009

‘There is ample, unequivocal evidence that finds patients have better health outcomes with more highly skilled staff.’

NSWNA General Secretary Brett Holmes.

care sector in Australia has had many negative consequences for nurses,’ he said.

‘We have concerns the introduction of such a health worker will place more pressure on nurses who will have to take professional responsibility for patient safety.

There is ample, unequivocal evidence that finds patients have better health outcomes with more highly skilled staff.’

Brett Holmes says the Garling Report did recommend the creation of other classifications to assist experienced and

skilled staff in our public hospitals.

‘I do not believe widespread replacement was his intention and his report is peppered with references to the need for experienced staff and appropriate clinical supervision,’ he said.

‘If this model is misused in any way to undermine the role of nursing in our public hospitals we will not hesitate to properly inform the public by whatever means necessary of the risks to patient safety.’n

nurses in public hospitals BETTER PATIENT OUTCOMES WITH QUALIFIED NURSES Research confirms that better patient outcomes come with higher numbers of RNs.

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ground-breaking study into nurse workloads in NSW public hospital medical and surgical wards, released in 2007, provided ample evidence that an increase in the number of RNs would greatly improve patient care.

The report, called Glueing it together, was conducted by a research team at the University of Technology, Sydney.

A skill mix with a higher proportion of RNs produced significantly decreased rates of nursing-sensitive, negative clinical outcomes.

The study found that an extra RN would reduce the incidence of decubitus ulcers by 20 per 1000 patients, pneumonia by 16 per 100 patients and sepsis by 8 per 1000 patients. A proportional increase in RN hours is associated with statistically significant decreases in decubiti, GI bleeding, physiological/metabolic derangement, pulmonary failure, sepsis and shock and failure to rescue.

Patients were less likely to fall and suffer injury as RN hours increased. The

presence of a nurse educator on the ward and an increased proportion of nurses working on their ‘usual’ ward were associated with fewer medication errors.

economy to reduce the ratio of skilled nurses to patients. This challenges the widespread worldwide obsession with reducing costs.

A skill mix with a higher proportion of RNs produced significantly decreased rates of nursing-sensitive, negative clinical outcomes.

English study links lack of RNs with an increase in deaths A similar large-scale and respected study conducted in English hospitals found a direct, statistical link between nurse staffing levels and patient outcomes.

The study focussed on medical and surgical ward-based RNs holding clinical caseloads. It found that had all general surgery patients in the sample been treated in hospitals with optimal staffing levels, 246 patient deaths could have been avoided.

The study also found a link between nurse-staffing levels and nurse satisfaction, burnout and quality of care.

A key conclusion was it may be false

The study was part of an international collaborative research enterprise where evidence from other countries backed the conclusions from the English research.

The study posed a key question: (a nurse) shortage is not just about numbers but about how the health system functions to enable nurses to use their skills effectively.

It suggests we need to know more about how nurses are deployed and how they apportion their time. We need to know how much of their time is spent on direct patient care compared to administrative duties and engagement with their colleagues.n THE LAMP JULY 2009 13

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C O V E R S T O R Y

Skills matter

by Mary Chiarella, Professor of Clinical Practice Development and Policy Research, Faculty of Nursing, Midwifery and Health at the University of Technology Sydney.

Mary Chiarella

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ommissioner Garling recommends in his report that NUMs require a support person to relieve them of many of the administrative duties they currently do, to enable them to re-focus on managing clinical care.

No-one could possibly disagree with this recommendation and everyone I speak to is delighted by this recognition of their need.

But looking at all the tasks that nurses are doing to fill the gaps left by the absence of other staff, there is probably a need for extra non-professional staff to take up some of these other roles too. Much of this work could be undertaken by assistants in nursing (AiNs) and could provide them with a valuable career path into enrolled and registered nursing programs.

We would be foolish, indeed, not to welcome an increased cohort of AiNs who might be able to relieve clinical nurses of some of this work while providing much-needed support to the clinical team.

There is a need for a critical mass of RNs to maintain safe staffing, and we cannot continue to dilute our existing skill mix in order to provide the clinical non-nursing support that the RNs and ENs currently working in the system so desperately need.

The difficulty here is we know budgets are limited. So, the question we need to think through is ‘what might be the cost to nurse staffing if we have more support staff’.

This introduction of extra support staff must not come about through a further reduction in RN numbers. That would be false economy.

What is required is a sophisticated unit-by-unit review of skill mix and staffing based on a range of sensitive parameters other than simply Full Time Equivalent (FTE) head count. Workload tools are a useful starting point, but they only tell you how many bodies you need, not what level of skill those bodies are required to process. The danger with FTE calculations alone is that if it looks like a body is all you need, then a body may be all you get. But upright and breathing is not enough. It never was.

This is why Duffield et al’s work (Glueing it together) is so important, because it looks at the relationship between skill mix and adverse events. Governments and their advisory bureaucracies should ignore it at their peril. It is the biggest study ever undertaken examining the relationship between these two issues at a unit level and Duffield has received

international acclaim as a result of it. For every 10% increase in RNs there is a 27% decrease in failure-to-rescue and we have wards in NSW where the percentage of RNs is already below 50%.

We have done a lot of work in NSW to encourage the introduction of many more junior nurses, both registered and enrolled, into the workforce and recently have been successful in increasing intakes of both new graduates and trainee enrolled nurses.

Much work has been done on reviewing our models of nursing care, and there has been a seismic shift away from patient allocation models of care delivery to team nursing models in an attempt to provide support for these less experienced members of the team (Chiarella & Lau, 2006, 2007).

But there is a need for a critical mass of RNs to maintain safe staffing, and we cannot continue to dilute our existing skill mix in order to provide the clinical non-nursing support that the RNs and ENs currently working in the system so desperately need. We need both quantity and quality, not either/or.

An increase only in upright and breathing bodies wandering around the ward is not only insufficient, it is a false economy. Adverse events cost money, much more money than extra RNs.n THE LAMP JULY 2009 15

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C O V E R S T O R Y

What nurses AiN ROLE THE BEGINNING OF A CAREER PATH Malcolm Leabon, RN at Royal North Shore Hospital.

Before getting his registration 18 months ago, Malcolm Leabon worked as an AiN for a nursing agency, mostly in aged-care facilities, residential care, mental health, and in medical/surgical wards.

Malcolm told The Lamp that having a clear career path was a big motivation for his entering the nursing profession.

‘I worked in hospitality and retail at the same time as becoming an AiN. I knew then I would want to progress up the career ladder, which meant studying to become an RN. But working as an AiN first was good preparation for that.

‘As an RN, I can really see the difference between new-grad nurses who have worked as AiNs, and those who haven’t. I recently worked with a student nurse who hadn’t ever showered a patient, whereas AiNs learn basic nursing and communication skills through practical experience,’ he said.

Malcolm says that generally there is a good understanding between RNs and AiNs with respect to their respective roles but he is concerned that an increased reliance on AiNs in the workforce will lead to a greater casualisation of the nursing workforce.

‘In an ideal world, all Registered Nurses would have some experience as an AiN and all AiNs would want to further their education, but in reality there seems to be an increased reliance on, and shift towards EENs and AiNs. I think the lack of Registered Nurses will mean agencies play a greater role in the future of nursing.

At the end of the day, it all seems to be about cost cutting, not nurse training.’

16 THE LAMP JULY 2009

MORE AiNS MEAN MORE RESPONSIBILITY FOR RNS Michael Grant, RN for DADHC at Stockton Hospital.

Michael Grant has worked as RN at Stockton Hospital and says he has noticed a significant increase in the reliance on AiNs at his workplace. ‘I’m very concerned about the affects the increase has on the workloads and responsibilities of RNs,’ he said.

‘Coping is very difficult, but there no longer seems to be any choice. There was originally an understanding agreed to by all parties that AiNs should account for 15% of the workforce. The next agreement was that any increase should be made according to an appropriate skill mix, and be approved by a workloads committee. But, despite that agreement, the reliance on AiNs has increased markedly. In fact, until this year, there was a staff freeze that meant the only permanent positions advertised were AiN roles, despite the shortage of RNs, and of ENs, too.

‘AiNs are generally a willing group of people but the expectations in Disability Nursing are high. They don’t have the same levels of understanding, and at the end of the day it’s RNs who are legally responsible for patient care. That means we’re sprinting all day trying to accomplish all the clinical work, as well as supervise the increased number of AiNs we’re responsible for. Also, administratively, the workload has increased, especially since many AiNs aren’t accustomed to doing this kind of paper work nor the amount of it. And, for others, their literacy and numeracy skills aren’t that strong.’

say WE CAN’T REPLACE EXPERIENCED AND SKILLED NURSES WITH UNLICENSED MINIMALLY TRAINED WORKERS Lyn Cohen, NUM of the Ambulatory Care Ward in a hospital in south west Sydney, says there is no place for the proposed Health Care Assistant workers to perform allocated nursing duties in the acute care setting. ‘People admitted to hospital are acutely unwell. They need high levels of observation and care by experienced, skilled and trained nurses. Health Care Assistants who have completed a short course (similar to the AiN Certificate III course) will not have the knowledge, background, training and experience to deal with very sick patients.

The introduction of Health Care Assistants to acute care will ultimately compromise patient care,’ said Lyn. ‘I am concerned these workers do not have nursing in their job title. They will not have nursing qualifications and they will not be part of a nursing career path.’

Lyn is also concerned the plan to introduce Health Care Assistants will be at the expense of RN positions and will put pressure on existing RNs. ‘RNs will still have their own patient load but will now be expected to also supervise Health Care Assistants. It will add stress, increase workloads and reduce skill mix on the wards.

‘The proposal undermines the traditional role of RNs,’ said Lyn.

THE LAMP JULY 2009 17

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C O V E R S T O R Y

Wayne Phillips CNS and Maree Tohi CNS prepare to administer nitrous oxide for patient sedation. Wayne has undertaken training to ensure the correct levels are administered. ‘Incorrect levels of nitrous oxide or inadequate monitoring would put the patient at risk,’ said Wayne.

Do we want unlicensed and minimally trained workers doing experienced nurses’ roles? g Every day, nurses on the Ambulatory Ward where Lyn Cohen works perform tasks that require high levels of skill and experience.

Maree Tohi puts in a patient’s cannula before dressing a serious burn.

18 THE LAMP JULY 2009

C O M P E T I T I O N

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Jamie Matthews, CNS from cardiac care, discusses a patient’s ECG results with Lyn Cohen. Jamie says the introduction of unlicensed care staff to acute care is just about cost cutting and it will be at the expense of patient care. ‘It will play havoc with skill mix on the wards. Nurses in the acute care settings such as ED, ICU, cardiac care, ambulatory care are highly specialised and are flat out with heavy clinical workloads as are all nurses in the acute care setting.

The Government is suggesting they should now also take on micro managing unlicensed workers. Introducing unlicensed workers is no solution to the nursing shortage. This model has been applied in the UK and it hasn’t worked’.

THE LAMP JULY 2009 19

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PROFESSIONAL ISSUES

New horizons for nurses in primary health care g New policy for primary health care urges a shift from hospital-based care to the promotion of health and prevention, with a strong contribution from nurses and midwives.

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broad range of nursing and midwifery organisations, including the Australian Nursing Federation, have released a paper outlining a vision for primary health care in Australia.

The paper urges a shift from the narrow perspectives of hospital-based care with its treatment and cure of alreadyestablished disease to the promotion of health, the prevention of disease and injury and the reduction of health inequities of all Australians across their lifespan.

The report advocates a holistic approach to health. It stresses that the physical, social, emotional and cultural wellbeing of the whole community, as well as the individual, is the key to good health, not just the absence of disease, injury or disability.

This consensus view of health supported by 22 nursing and midwifery organisations challenges the status quo.

The report’s vision of primary health care is based on a model of collaborative trans-disciplinary care rather than being led by any one professional group.

Health ministers … and medical practitioners have had a disproportionate say in the way health services are delivered and funded. Inevitably medical practitioners act as gatekeepers.

The report, Primary Health Care in Australia. A nursing and midwifery consensus view, stresses the strong contribution nurses and midwives can make to a new primary health care policy in Australia. In particular, it highlights health promotion and prevention for infants, children and youth and chronic and complex care management in the community.

Community mental health care, family health services and community aged care are other areas where nurses have an important role to play in a refocussed health policy.

In this model of care, nurses and midwives will be critical in helping communities and people of all ages become more self reliant and better able to manage their own health care needs.

20 THE LAMP JULY 2009

The report is frank and fearless in identifying the political obstacles to the implementation of such an approach.

Health ministers, principal advisers and policy developers, and medical practitioners have had a disproportionate say in the way health services are delivered and funded. Inevitably medical practitioners act as gatekeepers.

This power is linked to an almost complete commercial monopoly created through the restriction of access to funding sources, which has led to a number of distortions in the way the health system functions in Australia.

These distortions preclude one of the fundamental principles of primary healthcare – that of transdisciplinary teamwork.

NURSES, DOCTORS MEET TO DISCUSS THE ROAD TO COLLABORATIVE HEALTH REFORM Peak nursing, midwifery, medical and consumer groups met on 16 June to discuss a stronger, collaborative approach to health reform in Australia.

The AMA joined discussions with the ANF and other groups for the first time to develop a collaborative plan for a stronger primary health care plan that will deliver the best health outcomes for all Australians.

There was strong support among the 22 health care groups represented for a shift in focus from hospital-based primary care to health promotion and prevention.

The groups agreed a working group will meet in August 2009 to progress work on health reform in Australia.

The report also argues that Australia’s fee-for-service system creates an incentive for more rather than better services. It creates an incentive to provide many services, not make people better.

Another major defect is the limited incentives built into this predominantly market-based, fee-for-service system to encourage health promotion, disease and injury prevention or support strategies.n The whole report – Primary Health Care in Australia. A nursing and midwifery consensus view – can be downloaded from the ANF website – www.anf.org.au.

MERV improves men’s health

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ndrew Whale, Nurse Unit Manager for primary health care community nursing at the Greater West AHS, spends much of his time working from a caravan providing primary health care.

The Men’s Educational Rural Van (MERV) is a mobile men’s health checkup and information service that travels to workplaces and community sites in the Mudgee district.

Men have their blood pressure, blood glucose and cholesterol levels checked, followed by a discussion with a community nurse about men’s health issues.

They are provided with information

More than one third [of the men] had not seen a GP for a full health check up in the past year. about heart disease, alcohol consumption, smoking, prostate cancer, bowel cancer, sexual health, testicular self examination, healthy eating, exercise and mental health.

MERV aims to raise the profile of men’s health issues and increase the number of men accessing health services in the Mudgee area.

‘The response that MERV has received not only in Mudgee but throughout the GWAHS has been overwhelming,’ said Andrew.

Since the service started in 2005, 1246 men have accessed MERV and 51 visits have been conducted to local worksites or community events.

About half the men who have visited MERV are aged 41-60 and more than one third had not seen a GP for a full health check up in the past year.

Of the men who have accessed MERV, 83% came a second time and have followed most of the recommendations made on their first visit.n

Andrew Whale (right), Manager of the Men’s Educational Rural Van (MERV).

THE LAMP JULY 2009 21

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PROFESSIONAL ISSUES

Debbie delivers to the elderly

ebbie Deasley works as an aged-care nurse practitioner treating the elderly in their homes and keeping them away from the ED at Port Macquarie Base Hospital.

‘If someone is aged over 70 and can’t access their GP, I’ll go out and help treat them for a variety of things, including pneumonia, infections, delirium or checking catheters.’

Debbie says her role as a nurse practitioner gives the elderly more choices in their healthcare.

‘They like the one-on-one service.

They can ask questions and I’m not as rushed as a GP. I’m also looking at it from a nursing perspective so I take into account the family, the environment, medications and the education I can provide,’ she said.

‘It also empowers the residential facilities by enabling them to get a nurse practitioner in straight away to take care of something straightforward like dehydration.’

Nurse practitioners like Debbie are not only improving care but saving thousands of dollars by reducing hospital admissions, an ACT Health report shows.

A six-month snapshot of a nurse practitioner working in both a major tertiary hospital and in the community in Canberra saved at least 350 bed days at a cost of $1265 per day or $442,750.

Community dialysis service meets Indigenous patients’ needs

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22 THE LAMP JULY 2009

Lesley Salem, who runs the community dialysis service, is the first nephrology and Aboriginal nurse practitioner in Australia.

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nother effective nurseled health model is a regional community dialysis service that supports around 300 Aboriginal and nonIndigenous clients living within the 31,000 sq km covered by Lower Sector Hunter New England Health.

The service provides patients with renal replacement therapy for endstage kidney failure in the form of haemodialysis or peritoneal dialysis.

The program is run by Aboriginal nurse practitioner Lesley Salem and patients are cared for either at home or in one of five community satellite dialysis units. None of these settings has an onsite medical practitioner present.

The aim of the program is to provide renal replacement therapy and prevent complications of the outcomes, co-morbidities and causal diseases of kidney disease and renal replacement therapy, while maintaining the quality of life that suits the person receiving care.

Lesley Salem is not only the first nephrology nurse practitioner in Australia but also the first Aboriginal nephrology nurse practitioner.

Lesley covers all the centres with phone contact 16 hours a day; renal nurses staff the satellite dialysis units and run a home visiting service; a nephrologist visits one centre once a week; a dietician visits one centre once a week; and a social worker visits one centre three times a week.n

Coachstop outreach project brings hope to lives in chaos

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he Coachstop caravan park in Maitland is home to 150200 people classified as ‘at risk’ families and individuals.

Many park residents have been homeless, in prison and juvenile institutions, a number are from mental health facilities or refuges and some are transient moving from park to park in search of affordable housing.

Coordinated by Loretta Baker, the project has been successful in delivering a high quality health service on minimal funding.

With funding from the NSW Health Primary Healthcare and Partnerships, a two-year project was initiated with an onsite outreach van being staffed by an early childhood nurse, a registered nurse as project officer, and a psychiatric nurse specialising in clinical drug dependence.

At its core, the project aimed to help residents set their health priorities and plan strategies to address them.

The projects’ indicators of success were based on a holistic approach that reduced social isolation and improved housing options, increased personal skills and a sense of a supportive community, improved access to health services and increased maternal and child health outcomes.

Coordinated by Loretta Baker RN, the project has been successful in engaging socially and economically disadvantaged families and individuals living in the caravan park and delivering a high quality health service on minimal funding. The project has been successful in returning family members to housing, work, employment and health services.

The women now attend antenatal care and the children have access to childcare and preschool. And the broader community is now aware of the residents’ plight.n

Loretta Baker RN coordinates the successful Coachstop outreach project.

THE LAMP JULY 2009 23

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A G E D C A R E

Breakthrough on new ACS agreement g Negotiations for a new template agreement between ACS, the NSWNA and HSU have been finalised.

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any NSWNA members in aged care are set to benefit from a new template agreement between Aged and Community Services (NSW) (ACS), the NSWNA and the Health Services Union (HSU).

Negotiations for the new template agreements were finalised in late June and many ACS members are expected to sign off on the new template in July.

Agreements based on the previous ACS template agreement expire from 1 July 2009, and the new template agreement will provide new enterprise agreements between aged care nurses and care staff and more than 50 employers who are members of the employer organisation ACS.

ACS employers need to get organised and together ask their employer to offer the new agreement,’ said Judith.

The NSWNA claim for the new template agreement was based on a survey of NSWNA members working for ACS employers.

The top issues raised by members

The new template agreement will provide new enterprise agreements with ACS employers.

According to NSWNA Assistant General Secretary Judith Kiedja, agreements based on the new template agreement will not automatically replace previous agreements with ACS employers, which expire from 1 July.

‘Aged-care members working for

were a fair pay increase and a clear process to address unreasonable workloads.

‘The new template provides a 3% pay rise for the next two years, which is an excellent achievement in the current economic climate,’ said Judith.n

The Edith Cavell Trust

Scholarships for the academic year 2010 Applications for the Edith Cavell Trust Scholarships are now being accepted for 2010. Members or Associate Members of the NSW Nurses’ Association or the Australian Nursing Federation (NSW Branch) are invited to apply.

Applicants should meet one of the following criteria: 1. Student nurses undertaking full-time courses leading to initial registration as a nurse.

2. Registered or enrolled nurses who wish attend: 24to THE LAMP JULY 2009

an accredited clinical nursing education course of six months or less, either full-time or part-time; an accredited nursing conference or seminar relevant to applicant’s clinical practice.

3. Properly constituted nursing organisations, faculties or schools of nursing or registered or enrolled nurses wishing to: attend full-time, relevant postbasic studies at an approved institution for a period or periods of more than six months;

undertake an academically approved research program in the theory and practice of nursing work; conduct or fund a relevant professional or clinical nursing educational program.

Applicants must be currently registered or enrolled with the NSW

Nurses’ Registration Board (or the Registration Board of the state where practising).

Applicants must use the official Edith Cavell Trust application form. Details of the Edith Cavell Trust Rules are available on request and will also be supplied with the application form.

For further information or forms, contact: The Secretary – The Edith Cavell Trust PO Box 40, Camperdown NSW 1450  Mrs Glen Ginty on 1300 367 962  gginty@nswnurses.asn.au  www.nswnurses.asn.au – click on ‘Education’

Applications close 5pm on 31 July 2009

GOOD PAY RISE

Cooinda members AND OTHER happy with new IMPROVEMENTS template agreement

The new ACS template agreement includes:

c 3% pay rise per annum for the two years of the agreement (on top of the July 2008 increase provided under the current template agreement); c a clause that provides a mechanism for dealing with workload problems; c a requirement that employers consult with nurses and other staff over major workplace change; c an improved disputes procedure clause, bringing it into line with the new legislation.

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he new template agreement gets the thumbs up from members at the Cooinda Nursing Home in Coonabarabran.

Catherine McLean, RN and NSWNA Branch Secretary at Cooinda, said the new template agreement delivers a good pay rise and a process to address heavy workloads, and these are the most important issues for members at her workplace.

‘Our branch is happy we’ve had a say about what’s in the new agreement.

We held meetings about what we wanted in next agreement and most members here filled in the NSWNA survey.

‘Now we need to get organised and ask our employer for an agreement based on the ACS template. We’re asking nurses to join the union so we’re in a strong bargaining position.

So far we have 23 members in the Cooinda Nursing Home Branch. Many of us attended the NSWNA bargaining workshop,’ said Catherine.n

Members at Cooinda Nursing Home are getting organised for their next agreement (from left): Catherine McLean, Sue Stephenson, Anne Mathews, Liz Gordon, Kerrie Jones, Carol Boaz, Ami Mason and Bib Knight.

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A G E D C A R E

RNs warned on nursing home absence g Aged-care facilities and nurses may be breaching the Public Health Act.

A

ged care facilities are breaking the law if a lone registered nurse on duty in a nursing home also attends to residents in nearby ‘assisted living’ accommodation.

The NSW Public Health Act 1991, Section 52, says a nursing home must ‘ensure that a registered nurse is on duty in the nursing home at all times’.

NSWNA Assistant General Secretary Judith Kiejda says that if only one RN is on duty, she or he cannot legally divide their time between a high-care nursing home and so-called low-care hostel or assisted-living accommodation.

‘It doesn’t matter if the nursing home and assisted-living accommodation are in the same building or adjoining buildings,’ Judith said.

‘If you are rostered to work in a nursing home as the sole RN, you cannot leave the nursing home for your entire shift.’

The issue was highlighted by a recent dispute at a Blue Mountains nursing home.

The facility accommodated nursing home residents in high-care beds as well as others in assisted-living apartments (ALAs). The two sections were in the same building, separated by a door.

In the nursing home, a single RN covered the night shift with one or two

WHAT

RNS SHOULD

DO

junior nurses. A nurse would monitor the ALAs and, if necessary, call the night RN to attend.

RNs provided assessment, treatment and medication for ALA residents during all shifts, yet were paid an in-charge allowance only for the nursing home.

the EN or AiN can’t handle, they must call an ambulance – even if the resident doesn’t require hospital admission.

‘The ENs and AiNs are not happy with this arrangement because they feel too much responsibility is put on them.

‘If you are rostered to work in a nursing home as the sole RN, you cannot leave the nursing home for your entire shift.’

NSWNA Assistant General Secretary Judith Kiejda

The NSWNA branch at the facility sought a higher in-charge allowance because RNs were responsible for more than 100 beds.

Management refused on the basis that the Award provision did not apply to ALAs because such accommodation did not fall under the Public Health Act definition of a nursing home.

When the facility came under new ownership, management decided night shift RNs could no longer attend the ALAs because their temporary absence from the nursing home breached the Public Health Act. Secretary Judith Kiejda said a better solution would have been to roster two RNs at night or put a second RN in charge of the ALAs. ‘Now an EN or AiN visits the apartment residents at night and has to phone the RN for advice. If it’s something

If you are the only RN on duty, covering both a nursing home and a hostel or assisted-living accommodation, you can: 1. Contact the NSW Nurses’ Association 2. If your workplace has a NSWNA branch, discuss the issue at a branch meeting and suggest the branch write to management alerting them to a possible breach of the Public Health Act. 3. Take the issue to your workplace

The RNs are not happy because they are no longer able to provide the same level of care to the ALAs.’ Judith Kiejda said the case reflects a common problem across the industry.

‘ALAs or hostels are not legally considered high-care facilities but they often include high-care patients who were low-care at the time they were originally accommodated.

‘The Federal Government’s “ageing in place” policy, adopted in 1997, has made this situation more common.

‘High-care residents need quick access to a highly-trained nurse regardless of how the accommodation is classified.

The law and accreditation system for nursing homes has not caught up with the reality of high–care patients remaining in a low-care facility with lowcare staffing.’n

occupational health and safety committee. Ask management for a risk assessment of resident and nurse safety when nurses are attending hostels/assistedliving apartments.

4. In the meantime, document each occasion of service to the ALA/hostel in a record book or diary, noting the date and time, name of resident, care given, time of leaving nursing home and time returning. Keep a copy of the record book.

THE LAMP JULY 2009 27

s

I N D U S T R I A L I S S U E S

Keeping your job after a workplace injury g A permanent injury doesn’t give the boss the right to sack you.

A

Central Coast nursing home told an injured nurse it had no more work for her and stopped paying her – but claimed she had not been dismissed.

The company said there was no work for her unless she made a complete recovery and was able to resume all her pre-injury duties.

This was despite medical advice that she would never recover from the back injury sustained at work.

The Assistant in Nursing had almost seven years service at the nursing home.

This included working 65 hours per fortnight, in accordance with her medical certificate, for three and a half years after her accident.

During this time she was doing lighter, more manageable work such as organising recreational activities, cutting fingernails and cleaning dentures, and handling paperwork.

28 THE LAMP JULY 2009

When the NSW Nurses’ Association went to the State Industrial Relations Commission the company did not deny it had told the nurse there was no more work for her, had stopped paying her wages and superannuation and she had ceased accruing leave.

But it maintained it had not formally dismissed her and therefore the Commission had no power to order reinstatement.

Commissioner Donna McKenna accepted the union’s argument that the member had effectively been dismissed and the company agreed to re-employ her with back pay for lost earnings.

Commissioner McKenna said the company decided to send the nurse home without any prospect of returning to work unless she met the prerequisite of resuming pre-injury duties.

‘The fact that [the company] did not issue a letter of termination or arrange for the payment of termination monies is, really, neither here nor there,’ Commissioner McKenna said.

She said if companies were allowed to treat workers in this way it could remove employment protection for injured employees enacted by parliament.

It could also deny employees payment for untaken annual leave or long service leave that otherwise would fall due on

termination of employment, and prevent injured workers getting early access to their superannuation funds.

She said there were comparisons between this case and those where an employer stops giving work to a casual employee but claims a dismissal has not occurred in order to deny the employee access to legal remedies.

‘Employers in aged care – where injury rates are high – are the worst offenders.’

NSWNA General Secretary Brett Holmes.

NSWNA General Secretary Brett Holmes said the case underlines that nurses injured at work may legally be entitled to keep their jobs – even if they will never again be fit enough to resume all their pre-injury duties.

‘Providing you are capable of doing meaningful work, and such work is available, the union can press for your reinstatement even if you were terminated up to two years ago,’ Brett said.

‘A lot of nurses do not know they have this right.

‘Sacking someone because they can no longer cope with heavy lifting is not legally or morally acceptable.’

Brett said the union often acts on behalf of members dismissed after being injured at work.

‘Employers in aged care – where injury rates are high – are the worst offenders.

‘Too often their attitude to injured workers is, “chuck out the old and get me a new one”.

‘Employers will say “There is no more work for you but if you can go back to pre-injury duties give us a call”.

‘This contravenes the NSW Workers’ Compensation Act, which basically says you don’t have to be able to do all your previous duties to keep your job, providing you can do a reasonable portion of them and there is other meaningful work available.’n

Community home nurses ripped off g Survey reveals underpayments by private contractors.

T

he NSW Nurses’ Association and the Workplace Ombudsman are working together to investigate underpayment of nurses in the communityhome nursing industry.

A union survey of members showed non-payment and insufficient payment of travel time was particularly common.

The survey covered employees of seven private contractors including Department of Veterans’ Affairs contractors.

All but one company appeared to be systematically underpaying nurses.

The union sent the survey results to the Federal Government’s Workplace Ombudsman, which agreed to audit employers.

Meanwhile, the union is dealing with one employer in more detail through the courts.

‘We are determined to clean up the community-home nursing industry and ensure nurses are paid according to industrial law and agreements,’ said NSWNA General Secretary Brett Holmes.

He said the survey revealed widespread underpayment of travel time.

‘Travelling in your normal duties, such as between clients, is clearly work

time and should be paid at the hourly rate of pay.

‘It is our view and nursing industry practice that nurses who are directed to travel to a client as part of their normal duties should be paid their hourly rate of pay plus a vehicle allowance if they are using their own car.

‘We are determined to clean up the communityhome nursing industry.’

NSWNA General Secretary Brett Holmes.

‘Some employers are only paying a vehicle allowance. Others are paying the wrong allowance.

‘Some are correctly paying registered and enrolled nurses but not less qualified employees such as Assistants in Nursing.’

Brett said the survey also revealed underpayment for afternoon shifts and casual employees not receiving a minimum three-hour shift.

In at least one company, nurses who insisted on their legal right to minimum shift periods were victimised by having their hours cut back.

Some casual employees worked split shifts during a single day (for example, from 7am to 11am and then from 4pm to 7pm) but were not paid overtime as required by the Award.

‘Most nurses in this industry are paid under the Nurses Other than in Hospitals (State) Award. Some have a workplace agreement while others are on individual contracts,’ Brett said.

‘What you are entitled to depends on what award or agreement you are under.

‘If you think you may not be getting the correct pay, telephone the union on 1300 367 962.’n

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s

PROFESSIONAL ISSUES

Sabina Knight

Debra Thoms

Janine Shepherd

Justice Patricia

The art of caring g The 2009 NSWNA Professional Issues Conference explores new models of care emerging in response to evolving professional demands and opportunities for nurses. Don’t miss cutting-edge discussion on 31 July on how nursing care can evolve and excel.

T

he art of caring is a fundamental skill for nurses and midwives, but evolving professional demands and opportunities mean that models of care are changing, or need to change. The NSWNA has invited a diverse and inspirational group of speakers from nursing and nonnursing backgrounds to talk at the 2009 NSWNA Professional Issues Conference about many aspects of care, and facilitate discussion on how nursing care can evolve and excel.

Sabina Knight is the only nurse commissioner on the Rudd Government’s National Health and Hospitals Reform Commission. Sabina is also Professor of Remote Health Practice at Flinders 30 THE LAMP JULY 2009

University and has a longstanding passion for rural and remote nursing.

NSWNA members will be privileged to hear Sabina talk at this year’s NSWNA Professional Issues Conference about some of the Health Commission’s findings and recommendations and what they mean for the future of professional nursing care.

Margaret Morris is a Victorian Nurse Practitioner who will speak at the Conference about her involvement in changing the model of care in the dialysis unit at St Vincent’s Health, where she works. The model uses two nurse practitioners to oversee the routine dialysis care for over 200 dialysis patients, including those dialysing at the St Vincent’s site, patients in rural Victorian dialysis centres, and patients

The NSWNA has invited a diverse and inspirational group of speakers from nursing and non-nursing backgrounds to talk. on haemodialysis or peritoneal dialysis at home. The model allows doctors to focus on acute and complicated issues.

The model is supported by Professor Desmond Gorman, head of the school of Medicine at Auckland University, who recently described doctors as being like ‘747s being used to deliver milk’ because of the discrepancy between their knowledge and practice.

Advancing new models of nursing care is also an interest of Debra Thoms,

Staunton

Sue Pieters-Hawke

Hannah Dahlen

Margaret Morris

NEVER TELL ME NEVER : A MEMBER’S STORY Jacquie Myers is an RN, midwife and parent educator, as well as the NSWNA Branch President at Royal Prince Alfred Hospital. Eleven years ago her daughter Rebecca, then 15 years old, had a severe accident while competing in gymnastics, resulting in a broken pelvis and a fractured back

NSW Chief Nursing and Midwifery Officer. Debra will talk about NSW Health’s Essentials of Care Project, which seeks to develop a culture of critical enquiry into nursing care.

Political aspects of care will also be a focus at the Conference. Hannah Dahlen, Professor of Midwifery at the University of Western Sydney, and Justice Patricia Staunton, ex-General Secretary of the NSWNA, will discuss how lobbying and political organisation can help nurses achieve profession-wide goals that enhance and promote the value of care in society. Justice Staunton, who is the author of Nursing and the Law, will also discuss legal aspects of care.

Other keynote speakers on the day will be Janine Shepherd and Sue Pieters-Hawke, two of Australia’s most accomplished inspirational speakers.

Janine’s life story reads like a novel, and she has in fact written several best-selling books based on her experiences, the first of which, Never Tell Me Never, was turned into a feature film starring Claudia Karvan.

While cycling in the Blue Mountains as part of her training to compete in

in five places. Rebecca was distressed and depressed because the accident not only put an end to her gymnastics career, but also meant that she might not walk again because the fractures were not stabilising.

Rebecca’s surgeon gave her a copy of Janine Shepherd’s Never Tell Me

cross-country skiing at the 1988 Winter Olympics, Janine was hit by a truck. Her neck and back were broken in six places, her right arm, collarbone and five ribs were fractured, and she lost five litres of blood, which alone was enough to kill her.

Doctors warned her family that she was not expected to survive the ordeal.

But Janine did recover, and has since excelled in many professional fields.

While her bones were still held rigid in a full body cast, Janine was lifted into a plane to receive her first aviation lesson.

‘If I can’t walk, I’ll fly,’ she decided.

Janine has since received her commercial pilot’s license and has gone on to become a qualified aerobatics instructor.

Janine, who was told she would never be a mother, says her greatest achievement is raising her three children.

Janine has also received an order of Australia and is the patron of the Australasian Spinal Research Trust.

She plans to speak about her many experiences as a patient and outpatient, and to affirm the vital caring role that nurses play in so many people’s lives.

Sue Pieters-Hawke is an author,

Never, and the book not only inspired her to persevere through her painful recovery, but also to get a pilot’s license. Rebecca is now a personal trainer and student of political science, and is fully recovered.

Jacquie says Janine Shepherd is Rebecca’s personal hero.

personal coach and professional speaker who, until recently, was the primary carer for her mother Hazel Hawke, a prominent public figure and activist, even after being diagnosed with Alzheimer’s disease in 2002.

Sue is also the daughter of exPrime Minister Bob Hawke. In 2004, she co-authored the book, Hazel’s Journey, about her mother’s experiences with Alzheimer’s disease. Over 50,000 copies have been sold, and Sue is dedicated to creating awareness of the illness and raising funds for research.

Sue plans to speak about her own experiences as a carer. ‘I think most people have a lot of different carer roles in life. I’ve cared for my children, for my husband when he was ill, and of course for my mum,’ Sue told The Lamp.

Sue also plans to speak about her experiences as a care consumer. Hazel has recently been moved to a home where she will receive full-time professional care, and Sue has found some aspects of professional care to be fabulous, but also has some advice about aspects she thinks can be improved.n THE LAMP JULY 2009 31

s

A G E N D A

State Budget 2009 g State Budget provides funding for NSWNA campaign wins.

T

he State Budget has provided $14 million to fund an extra 80 Clinical Nurse Educator positions won by the NSWNA in last year’s pay campaign.

The announcement was one of two measures in the State budget last month branded ‘Investment in nurses’.

The second measure delivers the funding won by NSWNA in 2005 for 10-hour night shifts at Blacktown, Mt Druitt, Gladesville/Macquarie, Dubbo and Macksville hospitals.

The budget also listed a range of spending initiatives in response to the report of the Special Commission of Inquiry into Acute Care in NSW Public Hospitals – the Garling inquiry.

Initiatives for 2009-2010 are: c $44 million for 500 Clinical Support Officers to enable doctors and nurses to spend less time on paperwork ($176 million over the next four years); c $13.3 million for Emergency Physicians; c $8.6 million for 64 new Clinical Pharmacists to monitor the type, quantity, past use and combination of prescription medicines, educate patients about prescribed medications and advise junior doctors and nurses on the best use of medicines; c $7.4 million to ‘promote a positive culture’ and for training programs to prevent bullying; c $6.8 million for 45 additional rural junior medical doctor positions;

32 THE LAMP JULY 2009

c c

$6.35 million for extra cleaning staff in metropolitan and regional hospitals; $3.9 million for on-the-job training;

The budget also listed a range of spending initiatives in response to the Garling inquiry. c

$3.7 million ($14.8 million over four years) for 30 new Clinical Initiative Nurses, who will improve communication

c

c c

with patients and their families in the Emergency Department waiting room, organise x-rays so results are available when the patient is seen by a doctor and organise pain relief or a reassessment of priority for a patient if their condition changes while waiting; $3 million to employ more support staff to ensure single sex rooms and areas wherever possible; $2.8 million for additional allied health coverage for ward rounds; $2.3 million to assist rural patient transport and accommodation for clinical care.n

s

Q & A

ASK

JUDITH

WHEN IT COMES TO YOUR RIGHTS AND ENTITLEMENTS AT WORK, NSWNA ASSISTANT GENERAL SECRETARY JUDITH KIEJDA HAS THE ANSWERS.

Addressing unreasonable workload I am an RN working in a busy unit of a public hospital. I feel my workload is increasingly unreasonable. It is affecting my health and patient care.

What can I do to change my workload to a level I can manage?

It is easy to feel powerless to stop unreasonable workloads but there are practical steps you can take to address the issue. The NSWNA has recently released an updated guide to reasonable workloads. This provides a comprehensive plan towards manageable work through local management and the reasonable workloads committee. Key to getting results is gathering information about the workload as it is currently (eg. patient acuity/numbers, staff experience/ numbers, skill mix, shifts involved), as well as suggesting to management outcomes you would like to see and how they would work.

This guide is available on our website at www.nswnurses.asn.au under ‘policies and reports’.

What happens to part-timers on public holidays?

I work in a private hospital for a large employer. I am part-time, working up to almost full-time hours. Over the past few months I have been rostered on public holidays and have been given annual leave on those days. Should this be happening or should those days be given to me as public holidays?

As a permanent part-time employee you accrue four weeks annual leave per year, which means that, unlike full-time staff who accrue six weeks, you cannot be given an annual leave day on a public holiday. If a public holiday occurs on one of your regular working days then you should either be paid the public holiday penalties, if working, or given the day off without loss of pay if the employer does not require you to work. For public holidays occurring during a period of annual leave you should have an extra day added to your public holiday leave.

The clauses that cover this issue with the major employers are as follows:

Award/Agreement

Clause

Private Hospital Industry Nurses’ (State) Award

Clause 22 (iii) – (v)

Ramsay Health Care and NSWNA/ANF Union Collective Agreement 2209-2011

Clause 27 (iii) – (v)

Healthscope Group and NSWNA/ANF Union Collective Agreement 2008 – 2010

Clause 24 Part 1 (iii) – (v)

Healthe Care (NSW Hospitals) and NSWNA/ANF Union Collective Agreement 2009 - 2011

Clause 28 (iii) – (v)

Paid for mandatory course I work in a nursing home and recently staff were advised by management that they had been enrolled in

a course, which was on some employee’s days off. We were not paid to attend this course and want to know whether we should be paid.

It all depends on whether you were directed to attend the course, or whether you had the choice of going. If your employer directs you to attend an inservice or course outside of your normal working hours, then they must pay for the time spent at this course/in-service.

If, however, there is no requirement to attend, but they are happy to pay the course costs, then they are not liable to pay you for the time spent there.

It is important to determine whether courses are mandatory for you to attend or not, prior to attending, to avoid any confusion over whether you will be paid or not.

Meal break for six-hour shift I am an AiN who works in a nursing home. I work four shifts per week, each shift being six hours. I am given one tea break during each shift of ten minutes. A colleague believes I should also get a meal break, can you confirm this?

Yes, you should be receiving a meal break of 30 minutes on top of your 10minute tea break. Any employee who works in excess of five hours is entitled to a meal break, and this can be found in the Nursing Homes, &c., Nurses’ (State) Award under clause 2 Hours of Work and Free Time of Employees Other Than Directors of Nursing, subclause (ix) (b) … ‘employees shall not be required to work more than five hours without a meal break’.n

THE LAMP JULY 2009 33

s

OCCUPATIONAL HEALTH AND SAFETY

Protection from toxic drugs g New cytotoxic drug guidelines minimise nurses’ exposure to toxic cancer drugs.

Oncology CNC Vivienne Freeman from Royal North Shore Hospital.

T

hirty years ago, nurses working in oncology wards would complain of having constantly sore eyes and yellow hands from working with cytotoxic drugs.

Thankfully, times have changed and nurses can now expect to minimise exposure to these toxic chemicals, thanks to a new set of guidelines put together in part by one NSWNA member, oncology CNC Vivienne Freeman from Royal North Shore Hospital.

34 THE LAMP JULY 2009

A cytotoxic drug has a toxic effect on cells. These drugs are often used in chemotherapy because they inhibit the growth of cancer cells. They are also used to alleviate autoimmune conditions like rheumatoid arthritis, to suppress rejection in organ transplant patients, or to treat severe skin conditions like psoriasis.

The problem with cytotoxic drugs is they are also dangerous, and can damage healthy cells. Chemotherapy patients often have toxic side-effects from the

drugs, including nausea and fatigue. The drugs are generally only given to patients when the benefits would outweigh the potential damage.

But many nurses have to work with these drugs every day and are exposed to the potential harm on an ongoing basis.

Long-term exposure to the drugs can potentially cause liver problems, infertility, cumulative chromosome damage, and even cancer. Generally, the long-term risk is highest for patients who are treated with the drugs, but the long-term effects on nurses who work with them is unknown.

‘They can cause secondary cancer in one in 100 people who are treated with the drugs,’ said Professor Bernard Stewart, head of the cancer control program for South East Sydney and Illawarra Health. ‘There is no direct evidence for the causation of cancer for people who handle these drugs, but we still need to minimise exposure.’

A 1996 study published in the Archives of Environmental Health found that the cytotoxic drug methotrexate was present in urine samples of nurses who’d been caring for chemotherapy patients. The study also found that patients undergoing high-dose chemotherapy excreted methotrexate in their sweat. Since then, safety measures have improved, but sometimes still fall short.

Part of Vivienne’s job is educating nurses about chemo-safety – that is, making sure they understand how toxic these drugs are and that they require safety equipment to administer the drugs and deal with the waste.

‘In this age where the dollar counts, some of the chemo-safety gear is totally inadequate and unsafe,’ she said.

So far there have been no documented claims in NSW for nurses who have suffered from toxic exposure to cytotoxic drugs, but that doesn’t mean exposure doesn’t happen.

Vivienne spent up to ten hours a week for almost a year working on the new guidelines, in conjunction with WorkCover, the NSWNA and other organisations.

‘The guidelines were updated on the basis of a number of things, including

CYTOTOXIC DRUG GUIDELINES: RISK CONTROL FOR NURSES Long-term exposure to the drugs can potentially cause liver problems, infertility, cumulative chromosome damage, and even cancer. other guidelines, professional knowledge, plus the evidence for what is safe and what is not safe,’ said Vivienne.

The new guidelines cover everything from handling and administering the drugs to dealing with the waste products safely.

‘We are the people who administer chemotherapy, we are the ones dealing with the material waste, the IV lines and things, and it’s really important that people know how to deal with these drugs,’ she said.

She said that it is important nurses are represented when putting together any type of guidelines. ‘Nurses, and cancer nurses in particular, are a large part of the workforce who deal with this,’ said Vivienne. ‘It’s important we use our experience and knowledge to have a say.’

From a career perspective, Vivienne learned a lot from her work on the guidelines, and it was a substantial career achievement.

‘From my point of view it was a privilege, as I have a strong belief in protection of all staff who are dealing with chemotherapy and the resultant waste,’ she said.

‘You learn a lot about your subject, you get to work with people from other health professions who are interesting and give you another perspective on the subject in question. You also need to learn a lot of patience as it is a lengthy process.’

Most importantly, nurses need to be protected from long-term exposure to potentially harmful substances, and have the right to a safe workplace, according to Vivienne. ‘We do not know what the effects on us will be in years to follow and while all patients deserve the best treatment, staff also deserve the best means of protection from the side effects and toxicities of these drugs.’n

he OHS Regulation sets out a hierarchy of control (or ranking of controls) to manage workplace risks. The hierarchy takes the following order – elimination of the risk, substitution, isolation, engineering controls, administrative controls and personal protective equipment.

T

ELIMINATE THE RISK Ways of achieving this include: c purchasing cytotoxic drugs in ready-to-use concentrations to eliminate pharmacy preparation c establishing supply arrangements with a company or health care institution that specialises in the preparation of cytotoxic drugs.

SUBSTITUTION Using a less hazardous substance or a substance in a less hazardous form.

Ways of achieving this include: c purchasing single-dose preparations c purchasing cytotoxic drugs in a liquid form, rather than a powder form c using a least hazardous cytotoxic drug to achieve the desired therapeutic benefit c incorporating handling techniques that minimise aerosol generation c purchasing drugs in vials not ampoules c purchasing drugs in plastic vials, or vials reinforced with plastic casings.

ISOLATION Separating people from the substance by distance or barriers to prevent or minimise exposure.

Ways of achieving this include: c adopting closed-system operations c conducting drug preparation work in a properly-designed and secure cleanroom c placing dispensed drugs in impermeable packaging for delivery to administration areas c designating a cytotoxic drug administration area, which only permits entry to authorised people.

ADMINISTRATIVE CONTROLS Adequate supervision and training is paramount if work practices are to play an effective part in reducing employee exposure to cytotoxic drugs and related waste.

Ways of achieving this include: c allocating responsibilities for health and safety c minimising the number of employees who work with cytotoxic drugs c cleaning work areas regularly c keeping containers of cytotoxic drugs secure c incorporating handling techniques that minimise aerosol generation c prohibiting eating, drinking and smoking in work areas c developing and implementing safe work procedures (safe working procedures) for all work activities c providing appropriate information, education and training to employees and carers c storing cytotoxic waste in specific, clearly-identified areas, separate from other waste c developing emergency procedures to deal with spills.

PERSONAL PROTECTIVE EQUIPMENT Something worn that provides a barrier between the person and the hazard. This may include: c impermeable coveralls and gowns c head covering c closed footwear c overshoes c gloves of appropriate material and thickness c safety glasses c respiratory protective devices – respiratory filters must be inspected and maintained.

A full copy of the guidelines is available from WorkCover, or can be downloaded at: http://www. workcover.nsw.gov.au/Publications/ OHS/Training/Pages/Cytotoxic THE LAMP JULY 2009 35

s

N S W N A M A T T E R S

NSWNA Branch News

en across NSW have be g NSWNA members ing their union and ild bu th on m is th e activ rses’ rights. working to protect nu

The NSWNA held a recruitment BBQ at the Royal Hospital for Women.

A group of NSWNA nurses including NSWNA President Coral Levett were invited to a preview of the new ‘Breast Wishes’ musical.

Suzi Parker (right) and NSWNA Organiser Rita Martin (left) at the Jewish Board of Deputies Women’s Forum. The forum was held to discuss community advocacy and aged care issues. The meeting discussed how this particular community organisation could support the national ’Because We Care’ campaign and the Quality Aged Care Action Group (QACAG).

Sonya Hornery, State Labor MP for Wallsend (front row) and the Wallsend Community Against Privatisation Town Committee organised a protest meeting against the privatisation of the Wallsend Aged Care Facility.

36 THE LAMP JULY 2009

NSWNA branch officials attended an activist ’Fairness at Work’ course at the NSWNA. The two-day workshop equipped officials on handling a variety of situations in their workplace.

Concord Hospital members celebrated International Nurses’ Day by dressing up in various costumes including as a West Tigers footballer and ‘All Saints’ characters.

Members of the NSWNA Bloomfield Hospital Branch held a BBQ and branch meeting to discuss recent rostering issues at their workplace.

NSWNA Organisers visited members at the Stella Maris Nursing Home, Cronulla.

Mount St Joseph’s Nursing Home staff Tracey Levett, Margaret Norton, Vicki Newham, Marie Ricketts, Kate Cummins, Carmel Corbett and Noel Martens worked hard towards the accreditation of the facility in Young.

Photo courtesy of The Young Witness.

THE LAMP JULY 2009 37

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L I F E S T Y L E

Chéri g Escape to the decadent world of Paris in the early 1900s in Chéri, an absorbing film about a love affair between a beautiful courtesan and a spoilt younger man.

F

eeling those winter blues or stressed out with shift hours?

You could escape to the decadent world of Paris in the early 1900s in Chéri, a sumptuous love story between Lea (Michelle Pfeiffer), a beautiful retired courtesan, and Chéri (Rupert Friend), her Byronesque young lover. Chéri’s mother is Lea’s former rival, Mme Peloux (Kathy Bates).

With the cinematography portraying a rich Parisian world, a convincing cast is assembled. Pfeiffer’s attractive statuesque Lea is suitably matched by Friend as the boyish lover. Always entertaining, Kathy Bates has some great witty dialogue.

However, we are required to ignore the American and British accents and believe the leading characters are French.

Despite their beauty, sexual prowess, and much sought after personalities, courtesans lived lives that were socially constrained and isolated. The claustrophobic nature of their lifestyle is highlighted in this tale. Precluded from

38 THE LAMP JULY 2009

‘normal’ society and family life, Lea is nevertheless a successful business woman, but is also anxious about her fading beauty. Chéri is persuaded to leave Lea and make an arranged marriage in order to provide his mother with greater financial security. Fatherless, spoilt, and lacking parental love, Chéri finds love in his relationship with Lea, and feels abandoned without her. A Freudian-oedipal aspect to their relationship is inferred.

Vulnerable to the aging process, Lea is nevertheless portrayed as wise, a quality that doesn’t entirely convince. She is scared of becoming an aging grotesque tart like some of her older associates.

Equally vulnerable, the emotionallyimmature Chéri, aptly described by a bordello Madame as a ‘poor little rich boy’, becomes lost without her.

Review by Murray James, RN, St John of God, Burwood

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Like most absorbing movies, this story can be taken at many levels. On one hand, this is a sensual love story set in a sophisticated time of artistic flowering.

On the other hand, it is a dark morality tale about indulgent, self-absorbed lovers who are somehow fated. Overall, this is a rich, closely observed movie with much poignancy, wit and colour.n Chéri opens on 23 July.

GIVEAWAYS

The fox and the child g The Fox and the Child is a simple but magical story of a child who meets a fox, and is a wonderful celebration of nature.

I

f you enjoyed the documentary March of the Penguins you will definitely love this film. Luc Jaquet, the director, befriended a fox when he was growing up and he has depicted this story around the meeting. He chose to use a girl as the child and this brings a gentle emotion and softness to the film. There is little dialogue and Kate Winslet is excellent as the narrator.

This is a simple story of a child and a fox. The film starts with the landscape of the forest, meadows and mountains that are situated in France near the border of Switzerland. This simplistic story involves nature as a main player and takes a journey into the world of foxes and their survival. The landscape changes throughout the movie and you can feel the coldness of winter, experience the beauty of autumn and the changing colours of the leaves, and feel the warmth of summer and the richness of the foliage

Review by Liz Lyons, NE, Prince of Wales Hospital

that makes up the forest. When spring comes, plant animal and insect life emerges and forest life begins again.

The girl is 10 years old and has the freedom of wandering through the forest after school and in her holidays. One autumn day she first sees the fox and then becomes mesmerised by the animal. Over the next couple of years the relationship evolves between the child and the fox, with many adventures shared between the fox and the girl.

If you want to lose yourself in the wonderment of nature, which we now sometimes take for granted, this is a story for you.n The Fox and the Child opens on 9 July.

FOR NSWNA MEMBERS My Friends, My Loves An engaging romantic comedy, My Friends, My Loves is a bubbly spin on the ‘odd-couple’ set-up.

When Mathias (Vincent Lindon) moves from Paris to London’s South Kensington to join his best friend, the divorced Antoine, they decide to establish a new household for their kids by moving in together. They set themselves some ground rules: they will never call on babysitters nor will they ever bring any girlfriends home. It seems like the perfect solution for two single fathers in their thirties. But in reality life is not so simple, especially when Mathias starts to fall for the beautiful Audrey (Virginie Ledoyen.)

Juggling parental obligations, romantic intrigues and differences of opinion, we are drawn into the colourful world of the French ex-pat enclave in London and the intertwining destinies of its locals.

With a nod to the warm humour of screenwriter Richard Curtis (Notting Hill), My Friends, My Loves is tender and light-hearted entertainment.

In Cinemas July 16, 2009 The Lamp has 100 double passes to the preview of My Friends, My Love, 25 double passes to Chéri and 30 double passes to The Fox and the Child. To enter, email lamp@ nswnurses.asn.au with your name, membership number, address and contact number. First entries win!

WANTED We are seeking closet film buffs to share with other nurses their views on the movies they love and hate. It’s a chance to see previews of next month’s new releases.

Please contact us with expressions of interest to be part of our movie review team. Call Editorial Enquiries now on 02 8595 1219 or email THE LAMP JULY 2009 39 lamp@nswnurses.asn.au

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O B I T U A R I E S

Fighter for rights at work JACQUIE HART • 3 MAY 1945-14 APRIL 2009

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ith a character that was caring, charming and challenging, Jacquie was at all times the consummate nurse and unionist.

Born in Lockhart, Jacquie entered the wonderful profession of nursing in 1966 at St George Hospital and was soon to enter the world of industrial relations.

During the 1960s and beyond, student nurses were very much at the bottom of the ‘food chain’ but Jacquie had a real problem with that. She took offence at the expectation that the students had to be on the wards half an hour before their shift started. Quick as a flash, she contacted the Association and an organiser was at nursing administration’s doorstep. The practice ceased. As Jacquie remarked, ‘St George never let me forget it, but it was worth it!’.

Jacquie was soon to become a regular at the Association’s Annual Conference. She casually remarked to her colleagues not long before she died that she remembered going to a conference at the Trocadero and putting a motion from the floor for eight hours between shifts. Her seconder was Matron Margaret Nelson from RPA. This was history in the making. Thank you, Jacquie.

It has to be said that 1966 was a big year for Jacquie. Always the party girl, Jacquie was soon to meet a man at a Navy function who was to become the love of her life. Jacquie and Julian married in Hong Kong in 1970 and were, as described by Julian’s brother, ‘luminously happy’. A life with Julian and the soonto-arrive Samantha and Tracy took them on naval sojourns to London and to warmer climates in north Queensland.

There was a certain elegance to Jacquie. She loved beautiful clothes, jewellery and fine food and wine. Through her 18 years at the Commonwealth Department of Health and Ageing, Jacquie was always 40 THE LAMP JULY 2009

It was obvious the nurses needed a voice, so Jacquie promptly instigated the branch formation at the Department and was pivotal as the ANF representative. sporting some exotic piece of bling or other accessory.

Those 18 years as a Commonwealth Nursing Officer took Jacquie into the realm of aged care. From Standards Monitoring to the Resident Classification Scale validation, she carried her strong sense of professionalism and commitment to all corners of NSW. Highly regarded by her managers and the aged-care industry, Jacquie was very proud of her work and very loyal to her colleagues.

Without a doubt, Jacquie could be very strident about the rights of her fellow nurses at the Department. It was obvious the nurses needed a voice, so Jacquie promptly instigated the branch

formation at the Department and was pivotal as the ANF representative during the certified agreement negotiations. The Howard years were not known for their milestones in social justice or industrial harmony.

Over that long, long decade, Australians came to believe that ‘something was terribly wrong’ when confronted with such things as Howard’s excruciating inability to utter the word ‘sorry’ to a generation of indigenous Australians; the ‘children overboard’ scandal; the denial of knowledge of the abuse of prisoners at Abu Ghraib; and the dreaded WorkChoices. These were difficult times, but Jacquie held her ground.

As Nick Blake, Industrial Officer with the ANF, said in his tribute to Jacquie in the May issue of the ANJ, Jacquie did the often thankless task as delegate because of her ‘strong view that Commonwealth Nursing Officers were grossly underpaid, professionally undervalued and their employment was always at risk’.

She was instrumental in negotiating the professional development allowance for Commonwealth nurses and always actively promoted the objectives of the ANF. Feisty and a political animal at heart, Jacquie was seen as a bit of an anomaly because she lived in St Ives and joined the ALP Left. As Meredith Burgman, the former President of the Legislative Assembly, put it: ‘Jacquie was one of those lovely ALP members who just wanted to make the world a better place. She and Julian would turn up to help on all occasions with enormous enthusiasm and lots of jokes.

I think that’s what my lasting memory of Jacquie will be ... lots of laughs and jokes. Since meeting her (probably in the 1970s) during my time at Macquarie Uni I have been continually impressed by her intelligence, tenacity and her commitment to social justice. We will all miss her terribly.’

And so say all of us.n By the Commonwealth Nursing Officers, Department of Health and Ageing

Inspiring teacher, compassionate nurse PATRICIA SHIRLEY ELLERCAMP • 1930-2009

M

any Newcastle and Hunter nurses will remember Pat Ellercamp as an inspiring and dynamic teacher whose talents set many careers along the path to success.

Pat died on Easter Saturday, 11 April, after a long and debilitating illness.

Pat Ellercamp was a trailblazer. She commenced nursing as a 17-year-old trainee at the Royal Newcastle Hospital in 1947. She was required to resign, however, when she got married two years later.

In 1960, when she needed to return to the workforce because her husband John had suffered a disabling accident, she applied to commence her general training – again at the Royal Newcastle Hospital.

Pat became the first mature-aged, married student nurse at RNH to undertake (and this time complete) her general training. Pat, by this time, had three young children but, nevertheless, was still required to ‘live in’ at the Nurse’s Home, in compliance with hospital rules. She finally graduated in 1965.

She went on to complete her midwifery qualification, before joining the staff of the operating theatres at the ‘Royal’, where she became an expert and accomplished scrub nurse.

In 1968, when the Belmont District Hospital opened, she commissioned the first ED and ran the Department with

efficiency, wit, compassion and charm, endearing herself to staff and patients alike.

Pat joined the School of Nursing at the Royal, shortly before the move towards tertiary education for nurses, and became first Deputy Head of School and then Head of School - Midwifery. Her dedication to her students was absolute, and she spent many hours preparing stimulating lectures, as well as teaching, co-ordinating guest speakers, marking assignments and exam papers.

Patty was an inspiring teacher, and derived great pleasure from engaging and motivating her students.

Even in retirement, Pat loved a project and became, among other things, a member of the Hunter Health Consumers’ Advisory Committee.

Then she took on the task of training candidates as accredited Personal Carers, and also became a driving force within Newcastle University of the 3rd Age (U3A), where she set up an introduction to computers program, sourcing donated computer terminals, and even premises, from corporate sponsors.

Pat was a devoted mother and grandmother, whose pride in family achievements gave her great pleasure.

Pat’s energy, determination, intellect and sense of humour will be sadly missed by all who knew her.n

By Chris Ellercamp, CNE, Westmead Children’s Hospital

THE LAMP JULY 2009 41

s

B O O K S

SPECIAL INTEREST TITLE

Getting Sober: A Practical Guide to Making it Through the First 30 Days

Book me Therapeutic Relationships with Offenders: An Introduction to the Psychodynamics of Forensic Mental Health Nursing Edited by Anne Aiyegbusi and Jennifer Clarke-Moore, Footprint Books, RRP £22.95 : ISBN 9781843109495 In the text Therapeutic Relationships with Offenders, the author aims to clarify some important interpersonal and emotional needs that underpin forensic patients’ presentations within the clinical environment, in a way that is accessible to nurses. This book covers a number of specialist forensic areas from a psychodynamic perspective, such as women’s services, services for people with personality disorders, intensive care, and high security psychiatric hospitals.

Approaching this subject from a psychodynamics perspective is found to be a useful way of capturing the richness of clinical nursing experience in forensic services.

Psychology for Nurses and the Caring Professions (3rd edition)

By Jan Walker, Sheila Payne, Paula Smith and Nikki Jarrett, McGraw-Hill Publications, RRP $70.00 : ISBN 9780335223862 Psychology for Nurses and the Caring Professions includes new theoretical concepts and contemporary research. It provides clear and concise descriptions of psychological theories, research-based evidence, and practical examples of applications across the lifespan in different health and social care settings. This text is essential reading for

students undertaking pre-and post-qualifying diploma or degree level courses in nursing and health care, including nurses, midwives, occupational therapists, physiotherapists and radiographers. It is also a useful introduction to the application of psychology for professionals working in social care.

Creative Nursing Leadership and Management

By Carolyn Chambers Clark, Jones and Bartlett (available through Elsevier Australia), RRP $62 : ISBN 9780074716403 Creative Nursing Leadership and Management provides relevant theory and ties it to practice by allowing learners to use critical thinking activities in a safe classroom environment. Perfect for upper-level undergraduate nursing leadership courses (and for more advanced leaders), the text focuses on creating leadership opportunities and creative solutions; using information technology; managing resources and change; delegation and succession; developing staff; and creative political, legal, ethical, effective, and safe interventions to keep staff engaged.

Success in Practical/ Vocational Nursing: From Student to Leader (6th edition)

By Signe S. Hill and Helen Stephens Howlett, Saunders Elsevier, RRP $55.95 : ISBN 9781416056591 Success in Practical/Vocational Nursing: From Student to Leader uses an engaging, interactive, 1-2-3 approach that will help develop problem-solving skills which will be useful throughout someone’s nursing

WHERE TO GET THIS MONTH’S NEW RELEASES These books are all available on order through the publisher or your local bookshop. Members of the NSWNA can borrow any of these books and more from our Records and Information Centre.

For borrowing information, contact Jeannette Bromfield, 8595 2175, jbromfield@nswnurses.asn.au or Cathy Matias, 8595 2121, cmatias@ nswnurses.asn.au 42 THE LAMP JULY 2009

Reviews by NSWNA librarian, Jeannette Bromfield.

PUBLISHER’S WEBSITES c McGraw-Hill: www.mcgraw-hill.com.au c Elsevier Australia: www.elsevier.com.au c Wolters Kluwer Health/Lippincott Williams and Wilkins: www.lww.com c Jones and Bartlett: www.jbpub.com

By Kelly Madigan Erlandson, McGraw-Hill, RRP $24.95 : ISBN 9780071493772 Already hailed as a thoughtful and comprehensive guide to those early, crucial days of sobriety, this ground-breaking new book is different from anything else on the market. As an alcohol and drug counsellor for more than 20 years, who has helped thousands into recovery, the author does not focus on trying to diagnose the problem.

Instead she compassionately guides you through the first 30 days of sobriety – the most crucial part of recovery. She gives practical, day-byday advice for becoming and staying sober – from removing alcohol and alcohol-related items from your house to picking the recovery program that fits your needs. (provided by www.seekbooks.com.au/ isbn/9780071493772.htm) career. The opportunity for active participation and application of critical thinking is utilised through questions, quizzes, and self-assessments, providing you with practical and efficient aids to learning. You will also discover learning strategies, tips on taking the NCLEX-PN, guidance on job searches, and an in-depth discussion of supervision, delegation, assignment of tasks, and the distinctions among them.

Psychiatric Mental Health Nursing: An Introduction to Theory and Practice

By Patricia G. O’Brien, Winifred Z. Kennedy and Karen A. Ballard, Jones and Bartlett (available through Elsevier Australia), RRP $90 : ISBN 9780763744342 Psychiatric Mental Health Nursing provides a focused, thorough introduction to psychiatric-mental health nursing, including nursing assessment and intervention of the most common mental disorders as classified in the DSM-IV. This text guides nurses in managing special populations, clarifying neurobiological theories, and conducting psychiatric nursing evaluations. Additionally, the text presents the latest on psychotropic drugs, addresses legal and ethical concerns within psychiatric nursing, and discusses complementary and alternative therapies.n

THE LAMP JULY 2009 43

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s

N U R S I N G O N L I N E

New nursing research ere’s a snapshot of the latest research on nursing from the Australian Journal of Advanced Nursing.

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Health and the global financial crisis Ged Kearney, Federal Secretary, Australian Nursing Federation It has been said health care and nursing are recessionproof industries because health care will continue Ged Kearney to be needed. Indeed, given that health is directly related to social determinants such as adequate income and well-being, our services may well be in even higher demand, with people out of work and under general stress regarding welfare.

To an extent this is true. But the crisis is and will affect us. Governments are under pressure to make savings. Private health providers will be concerned about returns on investments. Aged care, already under pressure and underfunded, may well find less funding coming its way. Nurses working in aged care, who in Australia are paid considerably less than nurses working in other sectors might, due to financial pressure, have to leave the sector to ensure a more adequate income elsewhere. We are already hearing of state governments in this country who want to freeze public sector wages and even renege on agreements. There is great temptation to strip resources from the costly health budget and that is worrying. c www.ajan.com.au/Vol26/26-4_

GuestEditorial.pdf

Living the experience of breast cancer treatment: The younger woman‘s perspective Elisabeth Coyne and Sally Borbasi The object of this research was to explore the experience of breast cancer for young women under 50 years of age and describe Elisabeth Coyne their personal experience of coping with breast cancer treatment.

The researchers found that treatment for breast cancer began so quickly following diagnosis that little time was left to adjust to the concept of a life threatening disease.

The severity of the effects from treatment influenced the women’s sense of person and ability to care for family. Fatigue, nausea and early onset menopausal changes were particularly troubling. Women described a positive resolve to survive.

The researchers conclude that treatment concerns for younger women are qualitatively different from those of older women. They consider they are too young to assume ‘the sick role’ and are not prepared for its sudden onset, neither are their support networks. The right kind of support can assist younger women and their families to cope during the early stages of diagnosis and intervention. c www.ajan.com.au/Vol26/26-4_

Coyne.pdf

Nurse practitioners in drug and alcohol: where are they?

Stephen Ling The role of nurse practitioner encompasses advanced levels of practice with the potential to prescribe a range of medications within a recognised area of practice along with the use of appropriate ordering of pathology tests and referral practices.

The nurse practitioner in drug and alcohol has the potential to support and enhance existing medical models of patient care in a variety of settings.

Employment of nurse practitioners may be a way of addressing workforce issues. The advanced level of practice and resultant responsibility also requires higher levels of remuneration, which need to be accepted within an advanced practice framework. In many cases this model of care may in fact be acknowledging existing practices in areas where nursing staff are forced to undertake more advanced roles, due to the shortage of appropriatelytrained medical staff. Collaborative care involving nurse practitioners can lead to increased access, reduced waiting times and longer consultation times.

Nurse practitioners in the alcohol and other drugs field have enormous potential to support other experts in collaborative care for patients with substance use disorders. This potential does not come without some additional financial costs but

the potential benefits to a health service in employing a nurse practitioner skilled in the management of substance use disorders can be enormous. However, the full potential of nurse practitioners in drug and alcohol will not be realised until financial arrangements for outpatient care become a reality. c www.ajan.com.au/Vol26/26-4_

Ling.pdf

The relationship between clinical outcomes and quality of life for residents of aged care facilities Professor Mary Courtney, Maria O’Reilly and Professor Helen Edwards It is widely assumed that improving care in residential facilities will Mary Courtney improve quality of life, but little research has explored this relationship. The Clinical Care Indicators Tool was developed to fill an existing gap in quality assessment within Helen Edwards Australian residential aged care facilities and it was used to explore potential links between clinical outcomes and quality of life. Social and spiritual quality of life was particularly affected by clinical outcomes and poorer status in hydration, falls and depression were most strongly associated with lower quality of life scores. Poorer clinical status as a whole was also significantly correlated with poorer quality of life.

The researchers concluded that hydration, falls and depression were most often associated with poorer resident quality of life and, as such, appear to be key areas for clinical management in residential aged care. However, poor clinical outcomes overall also adversely affected quality of life, which suggests maintaining optimum clinical status through high quality nursing care would not only be important for resident health but also for enhancing general life quality.n c www.ajan.com.au/Vol26/26-4_

O’Reilly.pdf The latest edition of Australian Journal of Advanced Nursing is available at www.ajan.com.au THE LAMP JULY 2009 45

The University of Sydney

The Faculty of Nursing and Midwifery helps nurses build skills to develop interesting research career paths.

Take the opportunity to enrol in one of four research degrees:

Great legal advice for Nurses

Faculty of Nursing and Midwifery

Bachelor of Nursing (Hons) Master of Nursing (Hons) Master of Philosophy Doctor of Philosophy

Maurice Blackburn are proud to be the lawyers for the New South Wales Nurses’ Association.

Free legal advice#

You will be encouraged to conduct ground-breaking research, improve patient outcomes and conditions, and develop your own future.

Questions about what course would suit you?

#

Conditions apply

Call the Association information line on 1300 367 962.

Please contact: http://www.nursing.usyd.edu.au or 02 9351 0693 Maurice Blackburn has offices in: Sydney T (02) 9261 1488

Newcastle T (02) 4953 9500

New offices in: Parramatta T (02) 9806 7222

Canberra T (02) 6214 3200

Visiting Offices Camperdown T (02) 9261 1488

Wollongong T (02) 9261 1488

Appointments for regional members can also be arranged.

Are you interested in Nursing Research? The opportunity to make a real difference.

www.mauriceblackburn.com.au

Sydney Information Session - Working in the UK 22nd July 2009 Limited places so book early!

Realistic insight into living and working in the UK Group presentation and personal consultations Hays Healthcare is hosting an information session to give you an insight into working in the UK. If you are considering either a working holiday or relocating on a more permanent basis this is an ideal opportunity to gain more information and have all of your questions and concerns answered.

During the session you will receive help and guidance with completing your UK police check (free through Hays Healthcare) as well as assistance with becoming registered to work in the UK through the relevant regulatory body. Hays Healthcare is looking for locum and permanent Nurses in various specialisms across the UK. The session will include a group presentation and personal consultations to make sure that you leave feeling completely organised and ready for your trip. It will be held on Wednesday 22nd July 2009 at Chifley Tower, Sydney CBD. For further information and to register please contact Caroline Morfoot-Pettit T 02 8226 9770 E caroline.morfoot-pettit@hays.com.au

46 THE LAMP JULY 2009

Specialist Recruitment hays.com.au

CRoSSWoRD Test your knowledge in this month’s nursing crossword.

1

2

3

4

5

6

7 8

9

10

11 12 13

14 15

16

17

18

19

20 21

22

23

24

s 1.

3.

7.

8.

11.

13.

16.

17.

18.

21.

ACROSS Hollow muscular organ (5) Respiring (9) Rhythm of 1 Across (5) Specialist for 2 Down (7) Cold (6) Normal (7) Streptococcal pharyngitis (5,6) Soap suds (6) Drag, haul (3) Required (6)

22. Skin around the eye (6) 23. Lower part of the spine (6) 24. Abnormally high blood sugar levels (8) s

DOWN

1.

2.

3.

4.

5.

Disease of the liver (9) Enamel structures of the mouth (5) Gut (5) Pimples (4) Warmth (4)

6. Acute diarrhoea, abbrev (6) 8. Shortness of breath (8) 9. Newborn (8) 10. Wounding, damaging (8) 12. Character, will (6) 14. Changed or modified (7) 15. Gland organ of the digestive system (8) 17. Respiratory organs (5) 19. Wee (5) 20. Cranium (4) Solution page 49 THE LAMP JULY 2009 47

DIARY DATES Conferences, seminars, meetings SYDNEY, HUNTER & ILLAWARRA AusMed Conferences • ‘Nurses: General Educ. Update’, 6–7 July, Quality Hotel Cambridge. Cost $438.90 • Nursing Management of People With Adult Diabetes, 30–31 July, Quality Hotel Cambridge. Cost $438.90 Info: (03) 9375 7311, www.ausmed.com.au Sydney CAREX 2009 Aged Care Expo 15–16 July, Rosehill Racecourse.

Contact: Wayne Woff, (03) 9571 5606 Web: www.totalagedservices.com.au Australasian Rehabilitation Nurses’ Assoc. NSA/ACT Chapter Annual Study Day ‘Diversity in Rehabilitation’ 24 July, 8am-4pm The Epping Club Free to members, $50 non-members Contact: Amanda Buzio 9808 9687 Australian Ctr for Grief & Bereavement International Educator Tour 09 Workshop 27–28 July, Sydney Vibe Hotel.

Contact: (03) 9265 2100, info@grief.org. au, www.grief.org.au

Grace Centre for Newborn Care at the Children’s Hospital at Westmead 20th Annual Susan Ryan Neonatal Seminar 7 August, Sebel Hotel, Parramatta Contact: gcnc@chw.edu.au, 9845 2720 Navigating Neuro, Neuroscience Conf.

8 August, WIN Entertainment Centre, Wollongong. Cost $88.

Contact: Fiona Roberts at fiona.roberts@ sesiahs.health.nsw.gov.au or Narelle Walton on 4253 4400 Australian College of Midwives NSW Branch Annual State Conf. 2009 ‘MIDWIFERY GOING FOR GOLD’ 7–8 Aug, Novotel Sydney Olympic Park.

Contact: 9281 9522, www.nswmidwives. com.au The Cardiac Society of Australia & NZ (CSANZ) Inaugural Indigenous Cardiovascular Health Conference 16–17 August, Sydney Convention and Exhibition Centre.

Contact: www.csanz.edu.au 9th Rural Critical Care Conference 21– 22 August, Wagga Wagga Contact: Jane Howorth, 6650 9800, www.ruralcriticalcare.asn.au

Infection Control Conference NSW Inc. ‘Roller Coaster of Infection Control’ 3–4 September, Luna Park.

Contact: Michelle Berarducci, 9745 9613, ica@nursing.edu.au, www.icansw.org.au Enrolled Nurse 16th State Conference ‘On The Crest Of Change’ 17–18 Sept, Bomaderry Bowling Club Cost: $250 non-member/$210 member Contact: 1300 554 249, garozn@ optusnet.com.au, www.enpansw.org.au Mind to Care 2 day symposium & 3 day international conf. on mental health nursing, Australian College of Mental Health Nurses 29 Sept – 2 October, Sheraton on the Park Contact: Sophie Secombe, 07 5528 2501, acmhn9@astmanagement.com.au Web: www.astmanagement.com.au/ acmhn9/default.asp Vascular 09 ’Innovation in Intervention’ 1–4 October, Shangri-La Hotel.

Contact: www.vascular2009.com 2009 Australian College of Nurse Practitioners Conference 28–30 Oct, Sydney Convention Centre

Contact: (03) 6231 2999, www.cdesign. com.au/acnp2009 Australian College of Nurse Practitioners – National Conference 28–30 Oct, Sydney Convention & Exhibition Ctr. Contact: Anna Boyes, anna@cdesign. com.au, www.cdesign.com.au/acnp2009 NSW Lactation College – Annual State Conference 30–31 Oct, Vibe Hotel, Goulburn St Contact: Lynne Hall, halls4@bigpond. net.au, www.lactation.org.au John Hunter Hospital Newcastle – Staff Health Professional Day 20 Nov, 8.30am–4pm, John Hunter Hospital. Cost: free, lunch will be provided.

Contact: Staff Health Unit, 4921 3501/ Leonie Crowder, leonie.crowder@ hnehealth.nsw.gov.au St Vincent’s & Mater Health Sydney Nursing Research Symposium 2009 ‘Phoenix Rising: Nursing Research At SV & MHS Back On The Agenda’ 26 Nov, St Vincent’s Clinic Function Room, 438 Victoria Street, Darlinghurst Contact: Liz McInness, 9739 2528, prfsm.research@acu.edu.au

A

re you a Registered/Division 1 or Division 2 nurse, with a current practicing certificate, working in an aged care facility or in the community aged care sector?

Do you need funding towards any of the following?

•Tertiary studies •Short course/workshop •Conference attendance.

You may be eligible for an Australian Government Scholarship.

the Fund Administrator on the freecall number 1800 116 696.

48 THE LAMP JULY 2009

$$

For further information please visit www.rcna.org.au or contact

Diary Dates Diary Dates is a free service for members. Please send diary date details, in the same format used here – event, date, venue, contact details, via email, fax, mail and the web before the 5th of the month prior, for example: 5th of May for June Lamp.

Send information to: Editorial Enquiries Email: lamp@nswnurses.asn.au

Fax: 9550 3667 PO Box 40 Camperdown NSW 1450

Dates are also on the web – www.nswnurses.asn.au

Please double-check all information sent is correct. The Lamp cannot guarantee that the issue will always be mailed in time for the listed event.

Special Interest Groups Special Interest Groups is now part of Diary Dates. If you are a special interest group, you now must send information about your event as above.

Due to high demands on the page, some dates too close to publication or too far in the future may be cut. Only Diary Dates with an advised date and contact person will be published. Diary

INTERSTATE AND OVERSEAS Canterbury League’s Club, 7pm.

APSACC 2009: Australian Public Sector Anti-Corruption Conference ’Taking responsibility, fighting complacency’ 28–31 July, Brisbane Contact: (07) 3360 6060, info@apsacc. com.au, www.apsacc.com.au Australian Public Sector AntiCorruption Conference – ’Taking responsibility, fighting complacency” 28–31 July, Brisbane.

Contact: (07) 3360 6060, info@apsacc. com.au, www.apsacc.com.au 4th International Conf. on Community Health Nursing Research – ’Health in Transition: Researching for the Future’ 16–20 Aug, Adelaide, SA. Contact: (08) 8354 2285, www.healthintransition2009.org.au CATSIN – Council of Aboriginal & Torres Strait Islander Nurses, 10th National Conference 10–12 September, Mercure Grosvenor Hotel, Adelaide.

Contact: (03) 5886-0505 Australian College of Midwives 16th Biennial Conference ’Women & Midwives – A Brilliant Blend’ 22–25 Sept, Adelaide Convention Ctr SA. Contact: www.acmi.org.au International Conf. on Cultural Connections for Quality Care at the End of Life 24–28 September, Perth WA. Contact: www.pallcare.org.au ANZICS/ACCCN Annual Scientific Meeting 29–31 Oct, Perth Conv. & Exhibition Ctr WA Contact: info@intensivecareasm.com.au th

14 Australasian Nurse Educators Conference 2009 in New Zealand 30 September – 2 October, Christchurch Convention Centre, Christchurch, NZ Contact: www.nursed.ac.nz

Reunions Austin Hospital PTS 157 (Heidelberg, Victoria) 40 Year Reunion Date: July/August, Victoria (TBA).

Contact: Dianne Walker, 0412 341 152, 9466 7267, Dianne@thewalkers.com.au Bankstown Hosp. 1969 nurses reunion 40th Anniversary of 1969 class of general nurses 5 September, Dynasty Restaurant,

Cost: ±$70.

Contact: Khing Sin McCotter, 0413 041 069, ksmccotter@optusnet.com.au RPA Hospital PTS Group July 1962 26 September, Tattersalls Sydney Contact: Rosemary Cuneo, rjohno@ bigpond.net.au Royal Prince Alfred PTS 1977 Reunion October long weekend, Camperdown VTA Contact: Judy (Mather) Massey, 0418 402 934, Jamass1@tpg.com.au/ Sue-Anne SAM Mills, sueanne@bigpond.net.au St George Hospital Kogarah Reunion 17 October, St George Leagues Club Contact: Jan Robson, 9570 5517/ Judith Cornell, jcornell@netspace.net.au Mater Graduate Nurses’ Association Annual Reunion Mass & Lunch 18 October. Mass 11.45am at ’Our Lady Star of the Sea’ Kirribilli. Lunch 1pm, Vibe Hotel, Milsons Point.

Cost: $50 pp (before 31 Aug)/ $55 pp (after). RSVP by 11 September.

Contact: Jillian O’Brien, 9900 7549, matergrads@matersydney.com.au Wollongong Hosp. Grad. 40th Reunion 7 Nov. Venue: TBA. Seeking graduates Contact: Carolynne Macdonald, 4228 8936, jeltzz@ozemail.com.au RPAH March ’73 Seeking interest. Contact: Dianne ‘McKentish’ Webb, 6926 1545, diannenathan@hotmail.com or on Facebook as ‘RPAH March ‘73’ Prince Henry & POW July 1979 PTC 30-Year Reunion Date: TBA. Contact: Gill Longbottom, 0402 848 542/ Karen Mcguire(Gilliman), 0408 269 414/ Lynne Dive(Mccarthy), kl.dive@hotmail.com Canterbury Hospital PTS July 1969 Seeking interest.

Contact: Lorraine Barton (Nee Hardy), 9773 6223, lorraine.barton@optusnet.com.au Bankstown Hospital PTS April 1979 Seeking interest.

Contact: Mary T. Ehlefeldt, mtehl@ optusnet.com.au St Josephs Hosp. Auburn – Feb ’77 PTS Seeking all nurses who commenced training February 1977.

Contact: Cathy Kerr, rkerr@ambos.com.au

Send us your snaps If you’re having a reunion, send us some photos and any information from the night, and we’ll try to publish them.

Other notices Treatment for Alcohol Use & Trauma Post-Traumatic Stress Disorder Study If you have suffered serious trauma or distress, you can participate in this Sydneybased study. Sponsored by NSCCH, RPAH and the National Drug & alcohol Research Centre. Contact: Dr Claudia Sannibale, 0414 385 149, c.sannibale@unsw.edu.au Nurses Christian Fellowship • Winter Dinner: 18 July, 7pm, Rhodes Phoenix Restaurant, Rider Boulevarde Rhodes. Info: Jane, 9449 4868 • Workshop ’Can I Forgive? Abuse in the Workplace’: 21 Aug, 7pm, 5 Byfield St, Macquarie Park. Info: Diana, 9476 4440 • AGM & Lunch: 5 September, 11am, Macquarie Park. Info: Jane, 9449 4868 ’Controversies in Public Health – Lecture Series 2009’ presented by The School of Public Health, University of Sydney.

• 5 August: The kindest cut of all: did we get it wrong on circumcision?

• 9 September: Is the genetic revolution overhyped?

• 12 October: Obesity: is the food industry more part of the problem than part of the solution?

• 19 November: Whither primary health care in Australia?

Venue: Eastern Avenue Complex, The University of Sydney, Camperdown, 5.30–6pm: refreshments, 6-7pm: lecture Cost: Free. Registration (essential) and information: www.health.usyd.edu.au

NSWNA events Upcoming NSWNA Committee of Delegates (CODs) Meetings 15 September, 17 November NSWNA 64th Annual Conference Conf.: 29 & 30 July • Prof. Day: 31 July

Crossword solution

NSWNA Branch Officials’ and Activists’ Training Program

2009 New Delegates Program Half day, 1pm-4pm for new delegates c Tuesday 15 September Venue: NSWNA Camperdown.

Negotiation & Advocacy Part 1 1 day, 9am-4pm for branch officials and activists c Wednesday 16 September c Wednesday 18 November Venue: NSWNA Camperdown

Negotiation & Advocacy Part 2 ‘The IRC, NMB and You’ 1 day – 9am-4pm Target group: those who have completed the Negotiation and Advocacy workshop in 2008 or Part 1 in 2008. c Wednesday 16 September, c Wednesday 18 November.

Venue: NSWNA Camperdown Full details will be sent to branches via General Secretary Circulars.

For more information contact Vicki Anderson at the NSWNA. Metro (02) 8595 1234 • Rural 1300 367 962

THE TROUBLE

WITH TUESDAYS You may be finding it hard to talk to our information officers on Tuesdays.

This is because Tuesday is the one day of the week when all our staff are in the office for staff and team meetings. These meetings are essential for information distribution and planning activities.

If at all possible, please don’t ring on this day as there can be considerable delays. But if you need urgent assistance, you will get it.

Our information department receives approximately 900 calls per week, and the phones are ringing hot from 8am to 5.30pm. We are working hard to meet your needs and thank you for your patience. Call 8595 1234 (metro) or 1300 367 962 (non-metro).

THE LAMP JULY 2009 49

NURSING & MIDWIFERY UNIT MANAGERS’ SOCIETY OF NSW (INC.) Locked Bag 3030 Burwood NSW 1850 • Phone: 97457525 www.numsociety.org.au • ABN: 68 014 575 993 Administration Assistant’s e-mail – Lsaunders@nursing.edu.au

ANNUAL CONFERENCE

Leading The Change Brian Dolan, Lean Thinking and Leadership Keynote Speaker

Date: Friday, 23rd October 2009 Venue: ANZ Stadium, Millennium Room Sydney Olympic Park, Homebush Bay, NSW

Register and get involved.

Early Bird registration ends Sept 25, 2009.

TAX RETURNS

REASONABLE PRICE

LOOKING FOR A NEW CAR?

Specialised Service for Nurses and Hospital Staff Maximum Tax Refund Within 14 Days sub. to ATO • Fees from Refund & Fully Tax Deductible • Professional, efficient, Personal Service, 7 Days • Negative Gearing, Shares/ Property, Capital Gains Tax • Overdue & Late Returns • Tax Planning

CONTACT OUR FLEETSALES SPECIALISTS ON:

02 9735 8498 OR nurses@gillenmotors.com.au PREVENTION IS BETTER THAN CURE

Over 15 years experience Michael Todd JPCFP FTIA, FTMA

Call Mike (02) 9808 3166 Austwise Tax

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Accountants and Reg Tax Agents 34/ 99 Anzac Avenue, Cnr Victoria Road, West Ryde NSW 2114

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HAVE YOUR CAR SERVICED BY FACTORY TRAINED EXPERTS. EXPRESS SERVICE AVAILABLE.

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Careers Health currently has positions available for RN’s & EEN’s in the following areas: x x x x

Corporate Emergency RN’s –Nth Sydney Corporate Team Leader RN’s –Nth Sydney Absence Management RN’s – Nth Sydney NUM Med/Acute/Midwifery – Western VIC

Contact Leslie Hall on (02) 8741 0400 for more information or send your resume to cv@ccjobs.com.au

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52 THE LAMP JULY 2009