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VOLUME 82 NO. 3 JUNE / JULY 2025
10
12
COVER STORY Tenacity wins 16 per cent pay rise at Ramsay
After more than 250 days of historic industrial action and three No votes, an overwhelming number of Ramsay members have voted to accept the company’s proposed enterprise agreement.
COVER STORY
It pays to stay in the fight
Three of our members at Ramsay talk to The Lamp about the tough fight to win a fair pay rise and improved working conditions.
PHS CRISIS
NSW Health ‘too slow’ to rescue bush services
A parliamentary committee finds NSW Health has been too slow to safeguard rural and regional healthcare services. And key stakeholders dispute the Ministry’s claimed successes.
18 PHS CRISIS
Maternity choices recede for young families
The fast-growing Central Coast is a magnet for young families but its maternity services are in decline
20 NORTHERN BEACHES HOSPITAL
Northern Beaches public-private partnership “at risk of failure”
A report by the NSW Auditor-General questions whether a public-private partnership “is the appropriate model to deliver the best quality integrated health care”.
22
RURAL AND REGIONAL
Little Wings boosts regional child health care
Since February a Sydney-based paediatrician has been flying to the central western community of Warren to see children who have been waiting up to six years for specialist appointments for their complex health needs.
COVER : Ramsay delegates Photographed by Sharon Hickey
Candish
GENERAL SECRETARY
Cruel compensation changes will harm nurses and midwives
Working families in NSW deserve and expect better from a Labor government.
The Minns government’s proposed changes to the workers compensation scheme will put nurses and midwives at greater risk of harm.
Under the proposal, nurses, midwives and carers would automatically be denied access to workers compensation for psychological injuries arising from excessive workloads.
Workers who were bullied or sexually harassed at work would have to prove it in court before being eligible for workers compensation, and the injury threshold to continue receiving payments would double to 30 per cent.
This proposal will disproportionately impact the health workforce. Research shows nurses, midwives and carers make up the largest cohort of workers with psychological injury claims. It found a staggering 150 per cent increase in the number of psychological injury claims by nurses and midwives over a nine-year period.
The government intends to make it harder for nurses and midwives to access support, by excluding work pressure as a cause of psychological trauma. This is extremely alarming as we know excessive workloads and staffing pressures are leading to burnout and poor mental health.
The health system has been like a pressure cooker in recent years as the nursing and midwifery workforce has been overwhelmed by unprecedented demand and chronic understaffing, all coming off the back of a global pandemic. It should surprise no one that this work environment is prone to hostility and a culture of bullying.
We recognise workers compensation needs reform but making it almost impossible for workers to access compensation after sustaining a psychological injury at work is not the way forward.
The health system has been like a pressure cooker in recent years as the nursing and midwifery workforce has been overwhelmed by unprecedented demand and chronic understaffing, all coming off the back of a global pandemic.
Labor pledged to stand by injured workers at the state election. It is unconscionable to backtrack on that pledge and go down the path of inflicting cruelty on its essential workers.
Nurses and midwives in NSW deserve and expect better than that from a Labor government.
MORE EVIDENCE OF A PHS CRISIS
The government shouldn't need any more evidence that the NSW Public Health System is under severe stress after the recent report by the Special Commission of Inquiry into Healthcare Funding.
The report found that the NSW healthcare system is underfunded and overstretched. Ominously it predicts that the system risks being overwhelmed by an avalanche of aging and chronically ill patients.
In the report Commissioner Richard Beasley made strong and pertinent observations on the critical state of the health workforce due to a “collapse of workforce planning” which had hit regional and rural areas hardest (see our series on the PHS crisis on pages 12-19).
The commissioner noted NSW Health staff had not had a significant pay rise for more than a decade and suffered from high levels of burnout.
“Workforce stress, fatigue, and burnout are serious issues, and particularly so in a public health system. It is a fact,
that many (workers in the NSW Health system) no longer share income parity with their counterparts in other states.”
The NSWNMA has repeatedly raised these issues in public and in our discussions with the government. The NSW health system is not fit for purpose, workforce issues are central to the problem, and renumeration is key to recruitment and retention.
Now we have an independent, objective analysis from an expert appointed by the government itself that concurs with ours.
Fixing our treasured public health system should be the highest of priorities for any Labor government. It is what working families in this state expect and deserve from the Minns government that they elected to office.
RAMSAY MEMBERS SHOW HOW
A word of congratulations to our members at Ramsay who have just achieved a 16 per cent pay increase after several years of strong campaigning (see page 8).
Ramsay members participated in more than 60 strikes including converging on the Ramsay Annual General Meeting last year, 21 bargaining meetings and three successful no-votes.
Their remarkable perseverance and resolve should inspire us all.n
Have your Say
Featured Letter
Looking for the exit door if we don’t fix the crisis in rural health
Recently, I was part of the NSWNMA listening roundtables with NSW MPs.
I will admit when I first heard we would be sitting across from Dr Joe McGirr MP, Member for Wagga Wagga, I thought “this is an interesting concept”. He wasn’t my local MP, and I thought, “Is this man really going to care? It's not like he is going to get our vote at the polls, so what does it matter to him?”
But I realised we must get the message out to politicians.
It is time that rural and remote nurses stand together, tell our stories, and have our voices heard. We owe it to ourselves, to our patients, and the wider community.
Despite my initial scepticism, I realised that yes, it was vital that we speak with MPs like Dr Joe McGirr.
Nurses from across the region came together to share our concerns, and Dr Joe was quite surprised about what has been happening out there in the world of MPSs.
He heard of nurses working without security onsite. Of staff locking themselves in nurses’ stations for their own safety, after experiencing escalating violence from patients.
Stories of nurses in MPSs constantly taking on extra duties because they have no access to HealthShare services after 6pm, and where the only doctor available is via video link.
He heard about the reality of staff shortages for rural ED nurses, who are doing the duties of up to five different people, including what only doctors do in city hospitals.
He learnt about the terrible skill mixes on the floor and rosters being changed without consultation with staff members.
He heard from nurses who are doing multiple overtime shifts, just to keep facilities running, who are burning out in an already burnt-out profession.
The more we spoke, the more questions Dr Joe had. We need more Dr Joes in parliament to help us fight to restore our failing health system.
If we don’t, more nurses and midwives will be looking for the exit door, either to another state or to another profession.
Joan Beattie, Registered Nurse, Holbrook District Hospital
Featured Letter
Election Reflection
Healthcare was a mainstay focus of the federal election campaign and something that the Federal Government felt they had a message and mandate to campaign and win on.
But what, pray tell, is the positive healthcare message that NSW Labor can run on?
The NSW Government has seen the largest industrial action undertaken by nurses and midwives on record. The doctors have taken unprecedented strike action and the psychiatrists have resigned en masse. Mothers are having babies on the side of the road in regional NSW because maternity hospitals are closing their doors. Yet this government continues to ignore the fact that they have some of the lowest-paid nurses, midwives, and doctors in the nation. They are hardly going to be able to boast of any achievements in the healthcare space come their election time.
It might be two more years before the next NSW state election, but it will be here before you know it, Premier. The voting public has clearly indicated they do value health as a primary policy and they do value the people who work in it.
They see right through your attempts to inflate the number of people missing treatment, as shown in the doctors' strike. They will not be fooled by your blatantly incorrect misquoting of wage costs for nurses and midwives. The public trusts nurses and midwives, we are always in the top three most trusted professions in the nation. Where are politicians ranked? One of the lowest. Your election day is coming, Premier Minns!
Linda Mobbs, Registered Nurse, John Hunter Hospital
Celebrate the achievement, but stay focused
After two years of tireless negotiations and three previous no votes, we’re overjoyed to have finally secured a landmark agreement for Ramsay nurses and midwives that delivers significant wins for our members. The three-year deal includes a 16 per cent pay rise, an extra two weeks of parental leave, and increased weekend penalties for casual staff.
Whilst getting to this juncture is a major milestone, we acknowledge that our work is far from over. It is still vital that we secure crucial improvements to staffing ratios
and push for more comprehensive safe staffing initiatives to ensure our members can provide the best possible care to our patients. To all our members who stood together in solidarity and fought for these hard-won gains: this is a significant step forward, but we're committed to continuing the fight for a better working environment and quality care. Progress happens, one win at a time. So let's celebrate this achievement and recognise how far we have come but stay focused on the work ahead – we won't rest until we've achieved the changes our members deserve!
Michaela Maljcov, Branch President The Border Cancer Hospital & EBA delegate
Tenacity wins 16 per cent pay rise at Ramsay
After more than 250 days of historic industrial action and three No votes, an overwhelming number of Ramsay members have voted to accept the company’s proposed enterprise agreement.
95 per cent of Ramsay nurses and midwives voted in favour of the agreement, which includes a 16 per cent pay rise over three years, of which 9.5 per cent will be paid in the next 12 months, as well as backpay from July 2023. The new agreement is the culmination of two years of tireless campaigning by Ramsay nurses and midwives.
Ramsay is the country’s largest private hospital operator with 39 facilities across NSW including hospitals in Sydney, Coffs Harbour, Port Macquarie, Newcastle, Wollongong and Albury.
There have also been significant improvements to conditions including:
• reduced patient loads for nurses in-charge of hospital
• restrictions on non-clinical duties
• increased paid parental leave for primary carers and supporting partners
• increased overtime and weekend penalty rates for casuals
• improved rights and paid leave for branch officials.
Ewan Gemmell from Southern Highlands Private says members should be proud of the pay rise and the improvements in conditions they won in the agreement.
RAMSAY DELEGATES CELEBRATE THEIR SIGNIFICANT PAY WIN
“We started off from a base of 8.5 per cent over three years, and despite Ramsay saying it was the best they could offer, we ended up with twice that,” he said.
Jess Griffis from Warners Bay Private agrees that the pay rises were significant.
“The pay increases that we secured is the thing that people are most excited about. Another big win is an
extra two weeks' parental leave for primary carers, taking it to twelve weeks. We also secured two weeks of parental leave for secondary carers, which Ramsay had never had before,” she said.
Jess says there are improvements in the agreement that should lead to better patient care.
“We secured a clause restricting the non-clinical duties that nurses do,
“Members participated in more than 60 strikes including converging on the Ramsay Annual General Meeting last year, 21 bargaining meetings and three successful no-votes, which was a testament to their remarkable resolve.” — NSWNMA General Secretary Shaye Candish
JESS GRIFFIS FROM WARNERS BAY PRIVATE AND EWAN GEMMELL FROM SOUTHERN HIGHLANDS PRIVATE
like making beds or food services, which can be fulfilled by other classifications. That will free up nurses for more time on the floor for actual nursing,” she said.
“Another one of the new clauses means that the nurse in charge of the hospital will no longer have a patient load. At my site, we don’t have doctors on site 24/7, so if a patient is noticeably deteriorating, we now have an experienced person on hand to jump in.
“No longer having patients being cared for by the nurse in charge of the hospital also means that nurse won’t be getting pulled away from their patients to handle in charge responsibilities and can have full focus on them to ensure that they receive things like pain relief on time.”
Anne Allsopp, a midwife at North Shore Private, says there is a significant gain for casual employees in the agreement.
“Another big win was that casual employees will now get their casual loading on weekends. Previously on weekends they were paid penalty rates but not a casual loading – now they will be paid both.”
She said while the pay rise was pleasing, she “was disappointed with the lack of movement on safe staffing or ratios”.
“We started off from a base of 8.5 per cent over three years, and despite Ramsay saying it was the best they could offer, we ended up with twice that.”
—
Ewan Gemmell, Southern Highlands Private
and three successful no-votes, which was a testament to their remarkable resolve to show they deserved to be valued and respected by their employer.
“As part of our claim we sought mandated shift by shift nurse/ midwife-to-patient ratios for all wards and units in Ramsay hospitals. Unfortunately, we weren’t able to achieve these crucial safe staffing improvements in this bargaining campaign but the fight for ratios continues.”
“Hopefully, improvements in conditions and pay will mean that more nurses and midwives stay in the profession.”
NSWNMA General Secretary, Shaye Candish, congratulated Ramsay members for their tenacity and determination to win better pay and conditions.
“This has been the union’s longest running campaign of protected industrial action and it’s a credit to each and every Ramsay member who took up the fight and didn’t give up,” Shaye said.
“Members participated in more than 60 strikes including converging on the Ramsay Annual General Meeting last year, 21 bargaining meetings
A Ramsay spokesperson told Workplace Express that “we thank our nurses and midwives for their engagement and feedback throughout the negotiation process, and we look forward to delivering the benefits secured in the new agreement”. n
It pays to stay in the fight
Three of our members at Ramsay talk to The Lamp about the tough fight to win a fair pay rise and improved working conditions.
“We weren’t going to agree to just any old offer they put on the table”
There was a pivotal moment at the beginning of the campaign which sent a message to Ramsay that “we weren’t going to agree to just any old offer they put on the table”, says Jess Griffis from Warners Bay Private.
“The first No vote at 81 per cent was a big achievement because it had never been done before,” she said.
“Then we had over 400 nurses and midwives show up at the Ramsay AGM outside the Sheraton in the middle of Sydney. It was a real show of force. And on top of that, about 80 of our members went inside because they are shareholders. After that Ramsay agreed to intensive negotiations.”
These actions weren’t spontaneous but the result of intense organisation in workplaces and cooperation between the branches.
“At Warners Bay, we worked closely with the Lake Macquarie branch as part of the Newcastle region group. Both of our hospitals had reps on the bargaining team. When people said, ‘We’ve got this issue at our hospital, how do you manage it?’ - you could swap ideas and experiences.”
Jess highlights the importance of strong branches: “Make sure you’ve got representatives in all your areas, in wards and units. At Warners Bay there were areas where we didn’t have anyone as a steward, but now we've got representatives everywhere.”
She says this strong organisation and spirit of cooperation bodes well for future campaigns.
“Going into bargaining next time, we will be more prepared, more confident in what we are doing, and we have the structures in place to pick up in the new campaign.”n
JESS GRIFFIS
“Having a branch helped people feel they had a say”
Personal growth and collective growth were the order of the day during the campaign at Southern Highlands Private, says delegate Ewan Gemmell.
“My hospital hasn’t had a branch before, and so it was a new experience … to be involved in industrial campaigning. I didn’t really expect all the support I got, especially from nurses on the ward. Having a branch and being at the bargaining table helped people feel they were involved and had a say,” he said.
“When you are on the bargaining team, you are constantly in touch with people from the other branches, and that gives you a lot of support and encouragement. You can feel quite isolated at times, but being able to tap into the wisdom and energy of other people on the team motivates you.”
The impact of the actions inside and outside the company’s AGM were striking, he says.
“I think having members inside the AGM was a bit of a shock: we certainly outnumbered the other people who were there. One member got up and spoke about their experience of working at Ramsay, short staffing, and the difficulties they had to face.”
Ewan says he learnt a lot from his involvement in the campaign.
“I really enjoyed being at the coalface, and seeing the process of negotiating an enterprise agreement was fascinating and a highlight of my career. We are representing the colleagues that we work with.
“I’m happy personally with the agreement. There are more things we need to do next time around to make it better, but this time around it was as good as we could get.”n
“We showed them we were a force to be reckoned with”
Member action focused the minds of Ramsay management, says Anne Allsopp, a midwife at North Shore Private.
“The negotiations were really difficult, but after three No votes, Ramsay seemed a lot more engaged in negotiating with us. I think they did not want to risk going to another vote without having endorsement from our Union, which played in our favour.
“We were able to get a few more things over the line. We showed them we were a force to be reckoned with.
“One of the most effective things was the protected industrial action we took over billing for chargeable items, which nurses and midwives were left responsible for.
“Anything that affects Ramsay's finances, they are obviously very sensitive about.
We were able to take that action without impacting patient care.”
The company’s intransigence had an impact beyond the workplace, she says.
“Overall, the public has been quite shocked at how Ramsay has treated midwives and nurses. They are very profit-driven. They keep saying they can’t afford to pay, but they can’t make that shortfall off the backs of nurses and midwives. Hopefully, they will do the right thing now.”
The campaign and its outcomes have had a positive impact on her workplace, she said.
“Workplace morale has improved incredibly, not because of any change in Ramsay, but because after two years of bargaining and protected action we have a united front, we have increased our membership and our means of communication. Our members are not frightened now: they feel they have a voice.”n
EWAN GEMMELL
NSW Health ‘too slow’ to rescue bush services
A
parliamentary committee finds NSW Health has been too slow to safeguard rural and regional healthcare services. And key stakeholders dispute the Ministry’s claimed successes.
Access to health care in remote, rural and regional NSW is in decline, with maternity services and mental health care now reaching a crisis point.
So said the Legislative Assembly Select Committee on Remote, Rural and Regional Health in a report published in March.
The Committee was established to monitor the implementation of recommendations handed down in a landmark 2022 Legislative Council report Health outcomes and access to health and hospital services in rural, regional and remote NSW.
The NSWNMA made a number of recommendations in a submission to the Committee last year.
The Committee’s March progress report singled out maternity and mental health services for special mention.
"The Committee was particularly concerned about the closure of birthing and obstetric units in rural and regional hospitals, and escalating workforce shortages that are impacting on mental health care," said Committee Chair Dr Joe McGirr, Independent member for Wagga Wagga.
“The challenges that we have highlighted in this report cannot be addressed by LHDs alone, and urgent action is needed at the statewide level to address these challenges.”
— Dr Joe McGirr MP
In a foreword to the report, Dr McGirr said the Committee was “deeply troubled to hear that access to many specialist services has declined over the past two years, with many rural and regional health services in crisis”.
He said the Committee was concerned that “the intent” of many recommendations of the 2022 Legislative Council report “remains unfulfilled, despite NSW Health reporting that these recommendations have been implemented”.
“There continues to be a significant divide between the progress that NSW Health is reporting and the picture being painted by key stakeholders in the regional health system.”
Dr McGirr said NSW Health was “still not approaching some areas of regional health reform with an appropriate sense of urgency”.
“Workforce shortages continue to hinder the delivery of specialist services, and crisis levels have been reached in specialties such as obstetrics and psychiatry.”
Mental health services “are being impacted by significant and escalating workforce shortages” and
NSW Health should prioritise the development of “a comprehensive, long-term workforce strategy for mental health services across remote, rural and regional NSW”.
Dr McGirr said there was “a genuine desire and willingness” among health workers to improve the condition of rural and regional health care in NSW.
“However, the challenges that we have highlighted in this report cannot be addressed by LHDs alone, and urgent action is needed at the statewide level to address these challenges.”
The report made 32 recommendations to the NSW government, including:
• urgent development of a statewide plan to maintain and re-establish maternity services
• measures to address shortfalls within the obstetric and midwifery workforces, as well as gaps in rural and regional paediatric services
• development of a long-term strategy for developing the mental health workforce. n
Maternity services closing down
A snapshot of maternity services in decline:
• Gosford Private Hospital –birthing services closed March 2025.
• Inverell Hospital – on bypass for birthing since 2024 (no anaesthetic cover).
• Muswellbrook – closed for birthing since 2022.
• Parkes Hospital – on bypass for birthing since 2019. The town’s sole obstetrician resigned in January 2025 leaving Parkes without obstetric services.
• Sydney Southwest Private Hospital – maternity services closed December 2024.
• Wyong Hospital Birth Centre –closed 2020.n
Decline in private births burdening public system
Public maternity services are coming under additional strain from the escalating closure of private maternity services.
The shutdown of private birthing units is “set to blow the national health budget unless there is an urgent fix”, The Australian reported in April.
Even on relatively conservative estimates, the decline of private births could cost taxpayers an extra $1billion a year, The Australian said.
The paper cited an economic analysis of birthing trends by Monash University professor Emily Callander.
Her analysis showed that “if a 50 per cent decline in births in the private system were to eventuate – a not unrealistic estimate – then taxpayers would subsidise public system antenatal care and labour ward delivery to the tune of $1billion annually”.
“Many thousands of women would be left with little option but to rely on public hospital antenatal clinics and to give birth in public labour wards.”
The Australian quoted Professor Callander as saying that a 10 per cent total decline in private birthing units would cost the public health system an extra $189 million per year.
“If there were a 30 per cent decline, taxpayers would foot a $380 million bill. If there were a 50 per cent decline, public hospital costs would soar to just shy of a $1 billion increase per year, increasing to $1.5 billion if private birthing became extinct in Australia.”n
MATERNITY SERVICES AT GOSFORD HOSPITAL HAVE BEEN IMPACTED BY THE CLOSURE OF MATERNITY SERVICES AT WYONG AND GOSFORD PRIVATE.
Desperate psychiatric patients redirected to ED
The decline in mental health services across NSW is chronic and escalating.
Cumberland Hospital is the oldest and biggest psychiatric facility in NSW and its assessment centre (previously known as Admissions) has been a first port of call for people seeking mental health support in Western Sydney for decades. However, the centre closed its doors to the public on January 21 – one of five wards and units “temporarily” shut down due to the mass resignation of psychiatrists in a pay and staffing dispute with the state government. Three units including the assessment centre (a total of 27 beds) still remained closed in late April.
Enrolled nurse Fran Cavallaro, secretary of the NSWNMA’s Cumberland Hospital Branch, has worked at the hospital for 37 years and the assessment centre since 1996.
“I still have patients coming to my front door seeking help even though we’ve been closed for three months,” Fran said.
“I have to go out and tell them that I'm sorry, we are closed to the public, and if you're in crisis you need to present to Westmead Hospital emergency department.
“Some of them are in a real crisis; they can’t sleep, or they’re suicidal and hearing voices.
“We have had Corrective Services turn up with court orders diverting people into treatment programs and we've had to explain that we’re closed, and they need to go to Westmead.
“It is distressing for us nurses because we are here to help people, not turn them away in their hour of need.”
“I recently had a middle-aged man –a patient well known to us – crying and begging for help because he knows Cumberland, he knows our procedures.
“So, I'm sending him and others to an overwhelmed and hectic ED rather than providing prompt assessment and advice in a calmer, more settled environment.
“They could be stuck in the ED waiting room for many hours before there's a bed allocated to them.
“Sometimes the people I have to turn away never make it up to the ED and may be lost to care.
“It is distressing for us nurses because we are here to help people, not turn them away in their hour of need.
“I have told the district (Western Sydney Local Health District) that I have a moral issue with having to turn people away.
“Where is the patient safety for those people that present to my door?”
NSWNMA MEMBERS RALLY OUTSIDE CUMBERLAND HOSPITAL IN FEBRUARY.
“Sometimes the people I have to turn away never make it up to the ED and may be lost to care.” — Fran Cavallarosecretary, NSWNMA Cumberland Hospital Branch
COMMUNITY MENTAL HEALTH UNDERSTAFFED AND
UNDER-
RESOURCED
Fran said that even after three months of closure, there had been no update on when the units would reopen – “despite my efforts to get answers at the district and local level on behalf of the NSWNMA branch.”
“The level of transparency from the district to the local level is quite poor and employees are often kept in the dark on issues of vital concern to us and our patients.”
A total of 206 psychiatrists were reported to have submitted their resignations in the dispute with the state government.
The state’s minister for mental health, Rose Jackson, told The Sydney Morning Herald on 14 February that 29 psychiatrists had withdrawn their resignations, 105 had “deferred” their departure and 71 had taken higher-paid visiting medical officer contracts.
Around the same time, 84 admitted mental health patients were stuck in Western Sydney emergency departments waiting for a bed on a
ward – with some waiting for as long as 90 hours, the Herald reported.
“Mental health staff say they have been left on hold for more than an hour calling NSW Health’s Mental Health Line to find a service that can take their patients,” the paper added.
Fran agrees that a lot of calls to the Mental Health Line may go unanswered.
“Nurses often call the Mental Health Line to get their patients into an outpatient community setting.
"However, community mental health teams have long been understaffed and under-resourced. They continue to struggle with unmanageable workloads – and have been for a long time.”
LOST MENTAL HEALTH BEDS
The decline in mental health services across NSW is chronic and escalating.
The Herald reported that NSW public hospitals lost 150 mental health beds in the five years between 2016 and 2022, according to Australian Institute of Health and Welfare data.
“Mental health services have been in crisis for years and the doctor resignations put the spotlight on the problem and widened the cracks,” Fran said.
“In parts of Western Sydney such as the Hills district, population numbers have exploded over the last 10 years, but our bed numbers have declined.”
At a rally outside Cumberland Hospital in February, NSWNMA members called on the government to meet psychiatrists’ pay demands, urgently improve mental health staffing and reopen closed units. The rally also raised the alarm about a Health Ministry proposal to treat psychiatric patients in general wards in order to overcome the shortage of mental health beds.
“The Ministry/LHD is considering placing patients whose primary diagnosis may be related to drug and alcohol issues or neurological conditions into general wards, even when they have a secondary diagnosis involving mental health,” Fran said.
“The ministry calls it remodelling but I call it rebranding.
"This isn’t about patient safety – it’s about maintaining appearances. The recent resignations forced a review of current practices, but the consequences of these decisions could be serious and sometimes fatal."
"The general ward is not a mental health unit, it's not designed, staffed or resourced to provide the specialised care, supervision and support that mental health patients need.” n
Staff shortages shrink birthing options
Maternity services in the New England area are “absolutely dire”.
When maternity services at rural hospitals in the New England region go on bypass or have high-risk pregnant and labouring women, they usually divert them to Tamworth Hospital, the region’s biggest.
However, Tamworth’s maternity unit is so short of midwives it sometimes cannot function as a rural referral hospital and must go on bypass itself. When that happens, women are usually sent to John Hunter Hospital in Newcastle, another 275km from their families and support.
Tamworth Hospital hit the headlines in October last year when a 60 per cent staff shortage in the maternity unit forced it to go on bypass more than a dozen times in four months. Among midwives interviewed by the media at that time was 26-year-old Zoe Sattler, who said that during her three years on the maternity ward it wasn't uncommon to have to work 18 hours straight with little time for a break before coming back for another shift eight hours later.
Zoe told NBN News she was quitting her full-time position at Tamworth Hospital to take a less-pressured 9 to 5, Monday to Friday job in the disability sector.
LEONIE GOLDFINCH, SECRETARY, AND JILL TELFER, FORMER SECRETARY, OF NSWNMA TAMWORTH HOSPITAL BRANCH
“There are critical shortages across the state, and it shouldn't be up to grassroots midwives or local management to fix a system that is so obviously broken.”
The staff shortage prompted Australian Medical Association NSW president Dr Kathryn Austin to warn of the potential for avoidable deaths of a mother and baby.
“Tamworth is the hub of that entire region that can offer that higher level of care [including] support for operating theatres, [special care nursery] – all the things you may need during birth. When that goes on bypass, the situation is absolutely dire.” Dr Austin told The Sydney Morning Herald.
By April this year, Tamworth’s maternity staff deficit had slightly improved to an estimated 47 per cent including unfilled permanent positions and maternity leave positions.
“JUST DON’T HAVE THE STAFF”
Leonie Goldfinch, secretary of the NSWNMA’s Tamworth Hospital Branch, told The Lamp the “chronic” shortage of midwives persisted despite “fantastic efforts by our local management to recruit staff including from overseas”.
“When other units in the region are on bypass it can be crippling to our staff at Tamworth to manage the presentations from those hospitals as well as the women from our own local area,” Leonie said.
“We often have to cap the number of beds at 12 in the 20-bed ward because we just don’t have the staff.
“Bed closures are never done lightly because we understand the impact it can have on the community.
“Our managers try really hard to get enough staff so as not to go on bypass. When that happens, women have to move away from their
support networks and arrange travel and accommodation and they lose faith in our service.
“We rely on midwives doing fly-in fly-out, plus agency staff and others from the Rural Reliever Program.
“Overtime used to be for when someone was sick, now it is to fill spots on the roster.”
Tamworth hasn’t had the staff to provide a home midwifery service since COVID-19 hit.
“Instead of us going out to women’s homes they have to drive up to an hour to see us at the hospital,” Leonie said.
“It’s a massive inconvenience to have to bring a newborn baby out in the rain or in a heatwave. The baby might also be sleeping or having feeding issues.”
THE SYSTEM IS BROKEN
Leonie is most concerned that the Minns government appears to be doing little to find solutions to the shortage of midwives.
“There are critical shortages across the state and it shouldn't be up to grassroots midwives or local management to fix a system that is so obviously broken,” she said.
“The government has to step in and actually make a difference.
“Instead, they are refusing to negotiate to improve our low rates of pay and substandard working conditions and are taking us to the Industrial Relations Commission.
“That approach does not help solve the staffing shortage at all.
“It’s the same for the psychiatrists and the doctors – the whole NSW health system is broken and the Minns government thinks it can rely on the goodwill of staff to pick up shifts.
“The government has got the whole health service offside because we all feel undervalued.
“Maybe part of the reason why we can't recruit enough staff is that there is no solution in sight from the government.”
“The government has to step in and actually make a difference.”
Alecia Staines of the Maternity Consumer Network told The Sydney Morning Herald that rural communities without maternity services experience higher rates of preterm and stillbirths.
“Once a maternity service closes, towns lose emergency care and operating theatres and effectively become geriatric units,” she said.n
REGIONAL, RURAL AND REMOTE AREA MIDWIVES FACE “STAFF DEFICITS, OUTDATED FACILITIES AND EQUIPMENT, OUTDATED RATIOS AND OUTDATED PAY”, TAMWORTH MIDWIFE NAMITAMI MUNIKWA TOLD A SYDNEY RALLY LATE LAST YEAR.
Maternity choices recede for young families
The fast-growing Central Coast is a magnet for young families but its maternity services are in decline.
Until recently, three hospitals provided maternity services on the NSW Central Coast, which has long attracted young families priced out of the Sydney housing market.
Expectant mothers could choose Gosford or Wyong public hospitals or the district’s only private maternity service at Gosford Private Hospital.
Gosford Private’s owner, Healthe Care, closed its maternity service in March because of declining profitability – a trend affecting other private hospitals (see story page 13).
Approximately 30 midwives were made redundant in the closure.
No babies have been delivered at Wyong Hospital since its maternity
unit was “temporarily” closed and converted to a COVID-19 ward in 2020.
Hopes that Wyong’s birthing unit would reopen were dashed when the Central Coast Local Health District quietly removed the baths in the birthing rooms and arranged for the unit to be converted to offices and sleeping quarters for doctors.
Today, the region is served by one surviving maternity unit at Gosford Hospital.
“This is the first time in my career that my job is causing me extreme anxiety”
And it is under such strain that it recently lost its accreditation to train obstetricians and gynaecologists because of concerns about clinical supervision and safety.
NSWNMA delegate at Gosford Hospital Dee Dobson has worked as a nurse and midwife for 21 years, mostly on the Central Coast.
Dee is a full-time midwife at Gosford Hospital and worked casual shifts at Gosford Private “because our full-time wage is not enough to make ends meet – even on the Central Coast”.
She said the loss of maternity services at Wyong and Gosford Private, which birthed more than 400 babies last year, was “causing great anxiety” for Central Coast expectant mothers.
“Women chose private hospitals and private obstetricians for a variety of reasons and now that choice has been taken away from them,” she said.
GOSFORD HOSPITAL STRUGGLING TO COPE
ABC News reported “an outpouring of community concern about the lack of choice for women in a region with a population of 350,000 and growing” and noted the risks of expectant mothers travelling longer distances for private obstetric care.
Despite the community concern, NSW Cabinet ministers failed to take a single question about the local health service when they held a community forum in Terrigal in April.
“Ministers avoided us (nurses and midwives) at all costs, but after the forum I managed to speak one-onone with Health Minister Ryan Park and Premier Chris Minns,” Dee said.
“I heard the same old story –we don't have any more money for health services.
“However, the government has given Canterbury Bankstown Bulldogs millions of dollars for stadium improvements (a $40 million grant to build a football ‘centre of excellence’), so it’s a matter of priorities.
“The Minns government would rather renovate football stadiums than look after the maternity needs of women on the Central Coast.”
She said Gosford Hospital was already struggling to cope with about 3000 births a year and would find it challenging to handle an influx of mothers and babies who would otherwise have gone to Gosford Private.
“Gosford Public maternity ward is often full, even though eight of our 32 beds are unfunded.
“We are chronically understaffed as our rosters come out, but no extra midwifery positions have been created.
“At the same time, we have a shortage of doctors.
“The LHD is trying to recruit doctors and registrars but for now we have locums running the hospital, which is stressful for the midwives.
POST GRADS COUNTED IN STAFF NUMBERS
The staffing crisis is made worse by the fact that postgraduate student midwives are counted in staff numbers.
“Students are supposed to work under the supervision of a midwife but they are too busy to watch the students most of the time,” Dee said.
“The Minns government would rather renovate football stadiums than look after the maternity needs of women on the Central Coast.”
— Dee Dobson
“We just have to check in from time to time and hope that the student will come to us when they are unsure or needs advice. This is a statewide practice in all maternity services.
“I trained at Gosford Hospital, first as a nurse and later as a midwife, and I have always been extremely proud of where I worked and always loved being a midwife.
“This is the first time in my career that my job is causing me extreme anxiety.
“The problems all stem from the NSW government not paying health workers enough money.
“As a result, obstetricians and midwives are leaving but Chris Minns is not listening.
“The doctor shortage is so bad that Central Coast LHD has not been able to hold any gyno clinic for nonlife-threatening procedures for over a year.”
Dee said doctors were leaving Gosford Hospital because their calls for more staff and better conditions went unanswered.
“Their numbers fell to the point where we no longer had enough obstetricians to provide support as a training hospital and we lost training accreditation from RANZCOG (Royal Australian and New Zealand College of Obstetricians and Gynaecologists).”
A spokeswoman for RANZCOG told The Sydney Morning Herald that “following significant consultation regarding concerns around clinical supervision and safety, the college has made the difficult decision to suspend training accreditation at Gosford Hospital from semester one, February 2025”.n
MEL HOYE, DEE DOBSON AND ELYSA WESTERDYK
Northern Beaches public-private partnership “at risk of failure”
A
report by the NSW Auditor-General questions whether a publicprivate partnership “is the appropriate model to deliver the best quality integrated health care”.
In the report, released in April, the NSW Auditor-General found that the Northern Beaches Hospital –operated by Healthscope - failed to reach the standards and key objectives outlined in its contractual project deed and, ominously, that the partnership was at risk of failure. Other key findings were:
• The hospital “recorded concerning results for some hospital-acquired complications and has not taken sufficient actions to address some identified clinical safety risks”
• The project deed, which governs the partnership, did not support the hospital’s integration into the local health district and broader health network
• Healthscope has no obligation or commitment to implement NSW Health initiatives – such as the Safe Staffing Levels initiative.
The report said the hospital “has recorded elevated rates of falls, third- and fourth-degree perineal lacerations, and birth trauma during the review period” and despite efforts to resolve these issues “repeated patterns of poor results are a cause for concern”.
It continued: “Healthscope is unable to determine the extent to which factors such as insufficient staffing or equipment result in minor harm or near-miss incidents at the Northern Beaches Hospital.”
The report noted Healthscope’s request in November 2023, and again in December 2023, that the return of the public portion of the Northern Beaches Hospital be brought forward by 14 years.
In its requests, Healthscope noted the risk to the viability of the Northern Beaches Hospital, citing insufficient funding, a lack of integration into the wider health network, and strained stakeholder relationships.
In January 2024, the Ministry of Health formally declined Healthscope’s requests, noting that Healthscope has no legal or contractual entitlement to withdraw from or vary the project in the manner proposed.
The Ministry of Health reaffirmed that Healthscope must continue to provide services under the terms of the project deed.
“Recent reported financial challenges for Healthscope confirm this is an ongoing risk for NSW Health to manage,” the AuditorGeneral said.
TENSION BETWEEN PROFITS AND CARE
In recent months, Healthscope, which was bought in 2019 by private equity firm Brookfield, has revealed that it is $1.6 billion in debt.
The report pointed out that the Northern Beaches Hospital publicprivate partnership is expected to provide services at a lower cost than if the state operated the hospital.
“However, the public-private partnership structure creates tension between commercial imperatives and clinical outcomes,” it said.
It points out that there have been several funding increases provided to Healthscope by NSW Health.
“In June 2024, the Northern Sydney Local Health District calculated
that over $73 million in additional funding had been provided to Healthscope to operate the Northern Beaches Hospital since the hospital opened in October 2018.”
The Northern Beaches Hospital is currently the only public-private partnership for comprehensive public hospital services operating in NSW. It serves 270,000 people on Sydney’s northern beaches.
The Auditor-General’s report recommended that “NSW Health should consider issues raised for this public-private partnership for any future arrangement”.
The NSW government has recently enacted laws that will prevent future public-private partnerships.
Healthscope has since renewed its offer for the state government to take over the public component of the Northern Beaches Hospital.n
“Healthscope is unable to determine the extent to which factors such as insufficient staffing or equipment result in minor harm or nearmiss incidents.”
— NSW Auditor-General
More folly and failure from the ideologues of privatisation
From the moment the privatisation of public health services on the Northern Beaches was mooted by the Liberal-National government led by Mike Baird the NSWNMA raised concerns that the model would lead to profits being put before care. Before the 2015 state election the then Liberal health minister Jillian Skinner said the hospital would cost the taxpayer $1 billion. Two months after the election the contract details were revealed showing that the private consortium, which included Healthscope, Leighton Holdings and Thiess would be paid more than $2.14 billion over the life of the contract until 2038.
Previous experiments in privatising public hospital services in Australia, including at Port Macquarie in NSW, read like a catalogue of folly and failure.
The then Liberal premier Mike Baird hinted at the ideological nature of the decision in the face of opposition from health leaders and experts, including the NSWNMA.
“I will support partnering with the private sector if we can deliver better facilities, improved services and great outcomes for the community. That’s what I believe in,” he said.
He wasn’t the only one who believed in the superiority of the private sector in health.
At the same time, the federal Liberal government led by Tony Abbott, with Peter Dutton as health minister, was conducting a full-blooded attack on Medicare and was drastically slashing funds to public hospitals.
NSWNMA OPPOSES
PRIVATISATION
Leading up to the 2015 NSW state election the NSWNMA ran a very strong campaign against this “Americanisation” of public health including the privatisation of Northern Beaches Hospital.
At the time this led to substantial criticism from conservative politicians and media.
In September 2016 health minister Jillian Skinner doubled down on the privatisation mania and announced she intended to privatise five more regional hospitals – at Maitland, Wyong, Goulburn, Bowral and Shellharbour.
Strong campaigning by NSWNMA members and community engagement stopped these privatisations in their tracks.
NSWNMA General Secretary Shaye Candish says upholding the integrity of public health is part of the union’s DNA.
“The NSWNMA not only sees itself as a defender of the nursing and midwifery professions, but also as a defender of the public health system,” she said.
“We were right to stand up for public health through the years and we will continue to do so into the future. If nurses and midwives don’t stand up for public health and safe patient care, who will?”n
THE NSWNMA RAN A VERY STRONG CAMPAIGN AGAINST THE “AMERICANISATION” OF PUBLIC HEALTH (INCLUDING THE PRIVATISATION OF NORTHERN BEACHES HOSPITAL) WHICH RESULTED IN A HISTORIC VICTORY TO STOP THE PRIVATISATION OF FIVE REGIONAL HOSPITALS.
Little Wings boosts regional child health care
Since February a Sydney-based paediatrician has been flying to the central western community of Warren to see children who have been waiting up to six years for specialist appointments for their complex health needs.
Amonthly clinic is run there by Dr Mary Iskander, an experienced Sydneybased paediatrician, who flies to the remote region with the support of Little Wings, a not-forprofit organisation that transports seriously ill children in rural and regional areas to city hospitals.
Nicki Callan, a child and family health nurse who works across Warren and Trangie Multi-Purpose Health Services, told The Lamp that Dr Iskander is nearly “halfway through a wait list of 50 children”.
“While previously dads had never been to our service, even dads are now reaching out and booking their babies for appointments.”
Without a locally based paediatrician, and with 1000km round trips to Sydney for specialist assessment and diagnosis taking up to a week, families in Warren and surrounding were being denied access to basic health care.
“Dr Iskander sees six children during each monthly visit,” says Nicki, who has been a nurse and member of the NSWNMA for 30 years.
“While that might not sound like very many, these children have complex needs and they have hourly appointments.”
NICKI CALLAN, CHILD AND FAMILY HEALTH (WNSWLHD)
When she began working in her position in 2022, Nicki discovered that “the Warren community had not had a child and family nurse for 12 months, while Trangie had not had one for 18 months.”
Since then, she has been working closely with local communities to bring much needed services and support to mothers and children.
CREATING CULTURALLY SAFE SPACES FOR CARE
Working with Mary Small, an Aboriginal Health worker in Warren, and in close partnership with the Warraan Widji Arts group, Nicki has been able to dramatically increase the engagement of mothers-to-be and their children with health services.
The first step was to build relationships with the community in culturally safe spaces.
“Mary Small quickly identified that there was poor engagement with our
Aboriginal families. Many did not utilise the Child Youth and Family service. So together we created the Bellies and New Life project alongside a local arts organisation.”
Nicki and Mary worked with the Warraan Widji Arts group, who gained funding through Aboriginal Affairs to provide a women’s group where mothers-to-be came together to paint and tell their story through their belly casts and their canvases.
“We work alongside mothers creating art, while Wayilwan elders teach mums-to-be women’s business. It is a culturally safe space where we can build relationships with women in the community.”
In this environment, working with mothers to make their belly cast, Nicki could develop a relationship with new mums and encourage them to start thinking about accessing child and family health nursing support before birth, rather than after.
“Mary says to me that while previously dads had never been to our service, even dads are now reaching out and booking their babies for appointments.”
The Bellies and New Life Team have now also partnered with the Trangie Local Aboriginal Land Council and Wungunja Cultural Centre to run a second community arts program for women in Trangie.*
THE NEXT PART OF THE PUZZLE
The belly cast project has seen a huge uptake in women accessing health services for themselves and their children, and a big increase in childhood immunisation rates.
“The problem was that while I could make initial diagnoses and referrals, there were still massive gaps in services and resources available to the many children exhibiting signs and symptoms of developmental delay, global delay and behavioural concerns.”
“Children commencing school for the first time in Warren and Trangie were behind the state and national average,” says Nicki.
Working with the school and the local health centre, Nicki has worked to increase speech pathology and occupational therapy assessments and programs.
“Our speech pathology and occupational therapy services have gone from just one service to five services. The NDIS team also attends every clinic to assist families with the process for further support.”
For school-aged children, NDIS requires specialist paediatric assessment and diagnoses before they can be allocated resources. So Nicki’s next task was to lobby for Dr Iskander to fly to Warren for monthly face-to-face appointments that are fully bulk billed.
NEVER ACCEPT NO FOR AN ANSWER IN CHILDREN’S HEALTH
“When we live and work in rural and remote communities, we often can become complacent. We accept that services are less, or we can feel powerless at trying to create change,” Nicki says.
“Under the United Nations Convention on the Rights of the Child, Australia has a responsibility to ensure these rights of children are recognised and upheld.”
“However, we should never, ever accept no as an answer when we are looking at the health and well-being of a child. Under the United Nations Convention on the Rights of the Child, Australia has a responsibility to ensure these rights of children are recognised and upheld.”
Although she can’t divulge details until an official announcement is made, Nicki is excited that another paediatrician, who learnt of Dr Iskander’s Warren clinic in a television news report, will soon establish a second monthly service in a neighbouring council area.
“These come at no cost to families and are the gold standard of health care delivery,” she says.
It has all been made possible thanks to a team effort, Nicki says, including her colleagues Mary Small, child and family nurse Sarah Webb, the practice nurse from the Warren Medical Centre, Chris Letton, the Warraan Widji Arts group and community elders, Little Wings, Western NSW LHD, the Royal Flying Doctor Service, Warren Rotary and even support from the NSW Health Minister, Ryan Park.
Meanwhile, a second arts group is about to commence in the nearby community of Trangie, offering a belly program.
“We have to continue to look outside the box to enhance our referral pathways for our children and families,” says Nicki.
* Additional funding for this project has come from Alkane Tomingley Gold Mine, Narromine Shire, FRRR funding, Western NSWLHD, and Grain Corp.n
Nicki
features in Stronger Together Awards
Nicki was acknowledged for her outstanding efforts to improve health outcomes in rural and remote communities through her projects Bellies and New life and the Little Wings program.n
SYDNEY-BASED PAEDIATRICIAN DR MARY ISKANDER
LITTLE WINGS PILOT GLENN BRIDGELAND
LORRAINE SMYTHE AND HER TWIN GIRLS ALISHA AND ALERAH WITH DR MARY ISKANDER AND LITTLE WINGS PILOT ANDREW BAILEY
New voices on NSWNMA Council
The Lamp welcomes two new councillors representing Aboriginal and Torres Strait Islander nurses and midwives.
Mat Grant, Nurse Manager
Newly appointed NSWNMA councillor Mat Grant first put his hand up to become secretary of the Justice Health Bathurst Branch when he noticed “an absence of a voice for employees within the prison”.
One of the first issues he took on was the policy on handling medications such as methadone. The branch successfully fought for a change in the policy that said that anyone, including correctional officers, could be a second signatory.
The issue highlights nurses' central role in the correctional system, says Mat, a Wiradjuri man. “It is a very autonomous role for nurses. We don’t have doctors regularly on site, so often nurses are the only clinicians.”
The branch also took on the way AINs were being rostered instead of senior nursing staff. “Management was trying to implement them instead of qualified nurses, but they don’t have the clinical scope.”
Rebekah Henderson, RN
As a student, Rebekah Henderson, now a dualregistered RN and midwife, joined the NSWNMA when her mother – a “big unionist” – told her: “You’ve got to be in the union because the union is for the people”.
More recently, in 2023 Rebekah spent a week in Brisbane working on the Unions for Yes campaign, an experience she says opened her eyes to the possibilities of solidarity within the union movement
“The union was saying ‘Ok, we are going to support you,’ because it is there to support all the people including Aboriginal and Torres Strait islander people.”
Rebekah, a Wiradjuri woman, was a founding member of the Aboriginal and Torres Strait Islander Member Circle, and now she is one of the two members elected from the circle to sit on the NSWNMA Council.
As a council member, Rebekah wants to bring issues that impact Aboriginal and Torres Strait Islander members to the Association’s governing body.
Mat’s experience in the health system is broad. He is currently seconded to the position of nurse manager of clinical practice and risk improvement at Bloomfield Hospital. His substantive role is the nurse unit manager of the mental health intensive care unit.
Now, as one of two new members on the NSWNMA Council representing the voices of Aboriginal and Torres Strait Islander members, he will bring his hard-won knowledge and experience to the Association’s highest decision-making body. Mat wants to see more recognition of the achievements of nurses and midwives who identify as Aboriginal and Torres Strait Islanders, who’ve faced more adversity “to get to where we are”.
“Mentoring programs targeted towards Aboriginal and Torres Strait Islander people are needed, as well as professional programs and opportunities.”
He will be advocating for issues that disproportionately impact the Aboriginal and Torres Strait Islander community, such as kidney health, heart disease, diabetes and liver disease and mental health care.n
One of Rebekah’s priorities is for the Association to tackle the culture values that Aboriginal and Torres Strait Islander members hold, as well as the cultural barriers they face.
“Improving understanding of cultural values, such as leave around sorry business as well as cultural practices, and support of Aboriginal and Torres Strait Islander nurses in the workplace culturally is a priority for me.”
Championing appropriate health care for Aboriginal and Torres Strait Islanders, from issues around diet and obesity to birthing on country is another priority, says Rebekah, who has worked as a nurse and midwife in various roles, including in oncology, haematology, and now works in a primary care role in Sydney’s Western Suburbs. “I think there is a long way to go, but things are changing. Recognition for birthing on country, and the value of having an Aboriginal or Torres Islander midwife, is groundbreaking for women accessing maternity services. They feel safe having an Aboriginal or Torres Islander practitioner assist them through the antenatal, birthing and post-natal journey.”n
“Mentoring programs targeted towards Aboriginal and Torres Strait Islander people and professional programs and opportunities are needed.”
“Recognition for birthing on country, and the value of having an Aboriginal or Torres Islander midwife, is groundbreaking for women accessing maternity services.”
Branch Beat
Branch Beat with NSWNMA Assistant General Secretary Michael Whaites
In New South Wales, all workers have a legal right to refuse to work in unsafe situations.
Section 84 of the NSW Work Health and Safety Act 2011 makes this clear.
It says: “A worker may cease, or refuse to carry out, work if the worker has a reasonable concern that to carry out the work would expose the worker to a serious risk to the worker's health or safety, emanating from an immediate or imminent exposure to a hazard.”
Nurses and midwives can exercise this legal right as individuals or as a group. They also have the right to seek advice and support from their NSWNMA branch and union staff.
The first step is to inform management verbally or in writing of your refusal to put yourself in danger.
You must make yourself available for suitable alternative duties.
Next, make a verbal or written report to SafeWork NSW. Your NSWNMA branch can help with this.
SafeWork may make interim recommendations for a safer workplace pending an inspection of the worksite.
Don’t assume management will act to fix the problem – or even follow SafeWork recommendations.
As we report below, NSWNMA members at Grafton Hospital have found they need to be vigilant and gather wide support from fellow workers to force management to make the workplace safer.
Saying ‘No’ to unsafe work
Alarmed by escalating violence in the emergency department, nurses at Grafton Base Hospital have used the Work Health and Safety Act to successfully pressure Northern NSW Local Health District to employ a second security guard.
It’s the latest chapter in a long battle by nurses to make the ED safer for staff and the public.
About three years ago, after a nurse was seriously assaulted in the ED, members exercised their right to refuse to work in an unsafe environment under Section 84 of the Work Health and Safety Act 2011. “ED nurses told management that if a security guard was not on duty in the ED by the start of night shift, then that shift would not take
the floor,” said Darren Demmery, president of the NSWNMA’s Clarence Valley Branch.
“They said they would make themselves available for work – just not in the ED.
“The nurses also phoned SafeWork NSW, which immediately recommended the LHD put a security guard in the ED 24/7 as an interim measure.
“Two hours later we had a security guard stationed in the ED – in addition to a guard already employed to cover the whole hospital.
“The action was taken by ED nurses as a group rather than the branch because it is not strictly an industrial matter and the union can’t be officially involved.
“The issue blew up again when three doctors had to crash tackle a patient to make themselves and everyone else in the department safe.”
“However, the branch helped and supported the ED nurses who are all NSWNMA members.
“As one of the hospital health and safety reps I am legally entitled to get assistance from anyone, so I chose to call on the union and their knowledge and expertise around safe work legislation.”
SAFEWORK RECOMMENDED A GUARD
Darren said SafeWork later inspected the ED and recommended a guard remain permanently stationed there.
“However, a year later on Christmas eve the LHD said we didn’t need a guard anymore because ‘he wasn’t doing anything’ and took him away.
“They failed to acknowledge that the guard is stationed in the ED to deter violence. His presence gives nurses some peace of mind that they don’t always have to watch their backs.”
The branch responded to the withdrawal of the guard by passing a resolution calling on the LHD to review hospital-wide security with a focus on the ED.
The LHD agreed to a review by the district security manager – then failed to implement his recommendation which endorsed a security guard in ED 24/7.
“The issue blew up again at the end of last year, when three doctors had to crash tackle a patient to make themselves and everyone else in the department safe,” Darren said.
“Around the same time, SafeWork came in for a scheduled review and issued five Provisional Improvement Notices. The main one was to put a guard permanently in ED – but again management refused to follow that recommendation.
LETTERS OF SUPPORT
“ED nurses then signed form letters provided by the branch which notified management that nurses would no longer work in the department without a security guard.
“About 70 colleagues around the hospital including doctors, surgeons and nurse managers also signed the forms as a gesture of support.
“When nurses told the LHD we were going to do a Section 84 again, and refuse to work in ED without a guard, the LHD took us to the Industrial Relations Commission.
“They claimed we were taking unauthorised industrial action but the IRC said no, we were simply exercising our rights under the Work Health and Safety Act.”
“We finally got the second security guard and we are negotiating with management as to where that guard will work.
“At present, he has to cover other areas of the hospital as well as the ED. “Guards also have to do non-security work such as patient transfers, which means they are not readily available in an emergency.”
Darren said ED nurses are ready to invoke Section 84 again and refuse to work in the unsafe department if management refuses to make it safer.
“Management can come and run the ED themselves if they feel safe enough.” n
“Nurses told management that if a security guard was not on duty in the ED by the start of night shift, then that shift would not take the floor.”
Ask Shaye
Minimum wage increases for aged care employees under the Nurses Award.
I am a registered nurse in a private aged care facility. I noticed that recently registered nurses may be entitled to an increase in pay. When I asked my employer about this, they advised that I am already being paid above the Nurses Award so they don’t have to increase my pay. Is this correct?
You could still be eligible to the pay increase. The government has not only increased minimum pay rates for nurses working in aged care but has also reclassified the roles of registered nurses under the Nurses Award. Your role might have been reclassified. If this happened, your minimum pay rate may have also increased. Please contact the Association so we can assist you further with this enquiry.
Classification upgrades in the PHS
How do I get an upgrade in my classification in the Public Health System?
The opportune time to commence an upgrade is at your annual performance appraisal review. Reviews should include changes and updates to your position description (PD).
If there is substantial change to your PD then an upgrade may be warranted. This is then processed by your line managers and ultimately to the Local Health District Grading Committee for adjudication. Committee adjudicators include some representatives from the Association.
All upgrades require incorporation of the Award’s minimum criteria into the PDs. Minimum criteria may include relevant postregistration qualifications and experience, including in the specialty field.
When it comes to your rights and entitlements at work, NSWNMA General Secretary Shaye Candish has the answers.
In addition, position upgrades of a 5 per cent or more pay increase are to be advertised. Consequently, the incumbent seeking the upgrade must apply for the position when advertised in accordance with the Recruitment and Selection of Staff policy.
Exempt from the above processes are Clinical Nurse/Midwife Specialist Grade 1 classifications. These classifications are personal grades. They are an extension of the applicant’s registered nurse position and classification and are subject to the Award criteria of experience and/or qualifications and being a specialist, leader and resource to the unit. For these roles, the upgrading process is to apply via line management. Maintaining the upgrade is subject to an annual performance review of meeting the Award criteria.
Forced to take annual leave
My manager made me go home on annual leave on a Sunday because the unit was quiet. Can I be forced to do this?
No. The Public Health System Nurses’ and Midwives’ (State) Award 2023, Clause 30 (vii)(c) provides that:
The employer should give each employee, where practicable, three months’ notice of the date upon which he or she will enter upon leave and in any event, such notice must not be less than 28 days Staff cannot be directed to utilise annual leave to meet the needs of the employer unless there are agreed plans in place in accordance with the Leave Matters Policy Directive which relate to excess annual leave. If you are not currently being managed for excess annual leave, and there is no action plan in place to reduce your leave accrual balance, you cannot be forced to take leave.
Access to sick leave after being told to go home for ‘observable symptoms’
I work in a public hospital. My NUM came to me with a letter stating that there were some ‘observable symptoms’ as I was limping and that I was to leave work, using my own sick leave until I had a medical clearance from my doctor. I did start the day with a limp but as the day went on it resolved. I went to my doctor, got a clearance stating I was ‘fit to perform the inherent duties of my role’ and was allowed to come back to work. Should I be reimbursed the sick leave I used for the time I had off?
If management notes any ‘observable symptoms’ they are bound by clause 3.2.3 of the Leave Matters directive. If the symptoms ‘pose an imminent risk’ to your safety or the safety of your colleagues or patients, they can direct you to go on leave.
However, the clause also states: ‘Where advice from a registered medical practitioner is obtained and subsequently confirms that the employee is fit for duty, and a direction to proceed on leave was unnecessary, they must be re-credited with any paid leave taken or reimbursed for salary for any period of unpaid sick leave in excess of two days, given that it is not unreasonable to expect that observable symptoms to have resolved in that time.’
The right to a break from work
I work as a senior nurse manager in the public sector and am expected to be on-call on days I don’t work. Is this correct?
No, not without a specific agreement between the Local Health District and the NSWNMA due to extreme circumstances to ensure the provision of services as described in the Public Health System Nurses’ and Midwives’ (State) Award (the Award).
It has been a long-standing entitlement for all nurses regardless of their seniority to be allowed to be free from work on a day which they are not rostered on duty (a rostered day off) and on the completion of the shift before proceeding on a rostered day off – Clause 4(xvii)(b). This right is important to ensure nurses get a break from work and ensures some level of work-life balance.
As an example, if a Senior Nurse Manager Grade 6 works Monday to Friday day shift, the LHD may require them to be on-call on Monday-Thursday after their shift but cannot ask or require a nurse to be rostered on-call on the Friday evening because the nurse is proceeding to a rostered day off work. The Award does not allow the nurse to be on-call on the Saturday or Sunday in this example, as they are rostered days off work.
An ‘Additional Day Off’ is considered a rostered day off work and therefore you cannot be required to be on-call on this day either, or the evening before it.
You also have a right not to be oncall on a period of leave or the day before proceeding on leave – Clause 4(xvii)(a).
Comparing pay and conditions with colleagues
I work in a private medical practice. Can I discuss and compare my pay and conditions with co-workers?
Yes. In 2022, the Fair Work Act 2009 was amended to give employees the right to discuss their pay and related conditions even if they have a pay secrecy clause in their contract.
You now have the right to:
• tell any other person your own pay (including at your previous employer)
• tell any other person about any terms and conditions of employment that are reasonably necessary to determine your pay (such as the number of hours you work)
• ask other employees about any of the above, whether they are employed by your employer or a different employer.
12-hour shifts and ADOs
Do all employees who do 12-hour shifts in the public health system get ADOs?
No. If you are a full-time employee working under a 12-hour roster pilot program, you are only entitled to an ADO where you work a mixture of 12-, 10- and 8-hour shifts. If this is the case, ADOs will be accrued pro rata based on the number of 10- and 8-hour shifts worked. If you are a full-time employee and work 12-hour shifts only, you are not entitled to ADOs.
Pressured to accept a new contract
I have been working for a medical centre for three years and my employer recently provided me with a new contract which they are asking me to sign. They have said that this is just a formality and that none of my terms or conditions will change. Should I sign the new contract?
No. You should seek advice from the Association prior to signing any new contract. It is not unusual for employers to ask or even pressure their employees to sign new contracts. Sometimes this can be for legitimate purposes, and sometimes not.
Contracts, including employment contracts, can only be entered into by agreement. You cannot be forced or pressured to accept a new contract, and you should contact the Association if this is occurring. Changes to the wording of your contract of employment can have a significant effect on your rights and entitlements. Some employers attempt to sneak through changes which are advantageous to them through a new contract which is presented as a mere formality. The Association can review any proposed new contract provided to you and advise accordingly.
Casual work while on leave
I am on maternity leave and not due to return for another few months, am I allowed to pick up casual work at a different hospital while I’m on leave?
From the Leave Matters for the NSW Health Service policy:
Employees are required to follow requirements in applying for and taking leave. The various types of leave outlined in this Policy Directive are for specific situations and must be taken for the purpose sought. For example, parental leave is to provide employees time to care for and bond with their children. Sick leave is granted to allow employees to recover from illness or injury, while personal carers leave is available to care for immediate members of their family who are injured or ill. Employees who plan to take up any secondary employment during a period of leave must seek prior approval. This means that even when you are on a period of leave such as maternity leave, you would still need to seek approval to undertake casual work elsewhere. Not doing so could be seen as a breach of the code of conduct.
Professional Perspectives
The length of the new grad program
I am a new graduate midwife. I have completed my new grad year based on hours, but my manager will not take me off the new grad program as she said I do not have enough experience in each area of midwifery to be a safe practitioner. How long can I be kept on a new graduate program?
The support given to new graduates does not stop once a certain number of hours has been achieved. Your pay will increase once you have achieved a certain number of hours, but if you are not considered safe enough to be practicing independently the new graduate year can continue. It would be proactive to ask for a meeting with your manager and educator/ facilitator to discuss the areas in which you need to show improvement and set learning goals to ensure you can demonstrate change and aim to graduate from your new graduate program in a timely manner.
Authorisation for Authorised Nurse Immunisers
I am an Enrolled Nurse and I want to become an independent Authorised Nurse Immuniser. Is this possible in NSW?
In NSW only a registered nurse or midwife – who has successfully completed an immunisation course that is accredited by Health Education Services Australia (HESA) – can work as an independent Authorised Nurse or Authorised Midwife Immuniser. This authorisation is provided under the following Authority for Registered Nurses and Midwives: https://www.health.nsw.gov.au/ immunisation/Documents/ authority-for-RNs-and-midwives. pdf
More information can be about immunisation on NSW Health: https://www.health.nsw.gov.au/ immunisation/Pages/default.aspx All nurses can administer medications with a valid order. This
The Association’s professional team answers your questions about professional issues, your rights and responsibilities.
could include immunisations, if local policy provided for this. Like with any nursing practice, it would be necessary to have the right education, training and competence to administer immunisations.
Maintaining registration
I have worked part time over the last few years and have just retired from my employment as a registered nurse. Should I renew my registration next year?
While we can’t advise yes or no it is important to consider your employment plans in the future and whether you would like to return to the workforce as a registered nurse
If you are unsure if you would like to take up casual or part time work in the next few months or years, you may wish to renew your registration. To renew your registration, you will need to meet the recency of practice registration standard (450 hours of practice within the last 5 years).
If you do not wish to return to the workforce, then you may consider not renewing your registration or choose to hold a non-practicing registration. The non-practicing registration type is suitable for individuals who stop all nursing/ midwifery practice but want to retain a protected nursing/ midwifery title.
Please contact the Association for further individual advice around your registration renewal as you transition into retirement.
Access to electronic medical records
I work in a community setting when at times patients are admitted to hospital. Am I able to look at their notes using electronic medical records to check their progress while they are in hospital?
No, if you are not involved in the care of that person at that time you do not have the authorisation to view their records. Electronic medical records belong to the LHD or the facility. To access notes
authority is required and will need approval from the LHD or facility. Nurses and midwives have an ethical and legal obligation to protect a person’s privacy which is included in the NMBA code of conduct.
Responsibility for manual handling education
I have recently been employed by a nursing agency. The agency is asking that I attend manual handling education before commencing work. Is it my responsibility to source this education?
The Work Health and Safety Act 2011 outlines the duty of care held by an employer. Under the act your employer has a duty to ensure you are provided with the training and instruction to protect you from risk that can arise from the workplace. So, if it is mandatory your employer should be providing you with the training.
Giving medications in the NDIS
I’m working within the NDIS, and care workers are giving medications – is this legal?
The NSWNMA strongly advocates that best practice is for nursing work to be undertaken by nurses (enrolled or registered nurses). We are aware that in various areas, support workers are working with medications. Anyone working with medication needs to have appropriate education and training.
The Poisons and Therapeutic Goods Act 1966 No 31 and Poisons and Therapeutic Goods Regulation 2008 outlines the legal requirements for medication management within NSW. Requirements vary dependent on the setting (e.g., hospital, nursing home, or home).
If you are concerned about patient safety, you can raise these concerns through the appropriate channels.
The NDIS Practice Standards and Code of Conduct can be found at: https://www.ndiscommission.gov. au/
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As a NSWNMA member, you (and your family) are eligble to join - another great benefit of your union membership!
To learn more about how we can support you and your family, scan the QR code or call 1300 900 310.
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WORLD
Nations agree to global pandemic treaty –without the US
Members of the World Health Organization have agreed the text of a legally binding treaty designed to tackle future pandemics more effectively.
The new agreement looks to avoid the disorganisation and competition for resources seen during the COVID-19 outbreak.
Key elements of the draft treaty include the rapid sharing of data about new diseases, to ensure scientists and pharmaceutical companies can work more quickly to develop treatments and vaccines.
It also gives WHO the role to oversee global supply chains for masks, medical gowns and other personal protective equipment (PPE).
WHO members also agreed that countries will have to ensure that pandemic-related drugs are available across the world in a future outbreak.
Additionally, they approved the transfer of health technologies to poorer nations as long as it was "mutually agreed".
Participating manufacturers will have to allocate 10 per cent of their production of vaccines, therapeutics and diagnostics to the WHO. Another 10 per cent will then be supplied at "affordable prices".
WHO Director General Dr Tedros Adhanom Ghebreyesus described the deal as "a significant milestone in our shared journey towards a safer world".
US negotiators were not part of the final discussions after President Donald Trump announced his decision to withdraw from the global health agency, and the US will not be bound by the pact when it leaves in 2026.
‘(The draft treaty is) a significant milestone in our shared journey towards a safer world.’
— AWHO director general Dr Tedros Adhanom Ghebreyesus
AUSTRALIA
Landmark decision on women’s pay
The path-setting win by aged care workers on equal pay has now been extended to another five awards where pay has been historically undervalued based on gender.
The Fair Work Commission has implemented improvements to workplace laws introduced by the Albanese Government in 2022 to lift minimum pay rates for a wide range of occupations.
Among those set to benefit are pharmacists on the award, who will receive a 14.1 per cent lift to their pay phased in over the next three years.
The Commission is also proposing substantial pay rises of up to 35 per cent for a wide range of occupations, including health professionals, dental assistants, and pathology collectors.
Early childhood education and care workers, too, will see their award pay rates lifted over five years, with an initial 5 per cent increase from 1 August this year.
These changes will directly increase the wages of an estimated 175,000 workers paid under those awards and indirectly assist a further 335,000 whose agreements are underpinned by those awards.
An ACTU report, ‘Minding the Gap’, reveals that stronger workplace laws were a major factor in the gender pay gap shrinking three times faster under the Albanese Government than under the previous Coalition Government.
The laws added gender equality as an objective of the Fair Work Act and empowered the Fair Work Commission to order wage increases for workers to address jobs that had been undervalued on the basis of gender.
MORE INFORMATION:
Read the ACTU report Minding the Gap – The 20 reforms that are closing the gender pay gap faster: https://www.actu.org.au/wp-content/ uploads/2024/11/Minding-the-Gap.pdf
WORLD
PSI condemns Israeli attack on healthcare workers
Unions around the world are taking action to push Israel to end the targeting and killing of health workers and first responders.
The United Nations reported the targeted killing of 15 Palestinian paramedics and rescue workers by Israeli forces on 23 March.
They included eight employees of the Palestinian Red Crescent and at least one staff of the United Nations.
The UN reported Israeli forces killed these health workers, “one by one” and buried them in a shallow mass grave in southern Gaza. Their bodies were only recovered eight days later.
The attack was roundly condemned by Public Services International (PSI) – the global union federation of workers in public services.
Israeli forces have killed at least 1060 healthcare workers and carried out 739 military strikes against 27 out of the 38 hospitals in Gaza.
They have also detained 517 health workers, according to the World Health Organization. More than 160 of these are still being unjustly held in prison.
Daniel Bertossa, the PSI General Secretary said PSI and its affiliates stand with healthworkers in Gaza.
“Health workers are not targets. They provide an essential public service which is central to building a better society, and must be protected against attacks, instead of being made targets,” he said.
“Attacks on these workers inflame hostilities, promote dehumanisation and create the circumstances for further human rights abuses and war crimes.”
‘Health workers must be protected against attacks, instead of being made targets.’
— Daniel Bertossa, PSI General Secretary
AUSTRALIA
Medicating away social problems
Antidepressants can be helpful but can’t fix chronic stress caused by social problems like debt, poverty, racism or domestic violence.
Too many people are being prescribed antidepressants to deal with stressful life events or social problems, according to researchers.
More than 14 per cent of Australians are currently taking antidepressants, one of the highest rates in the world.
Dr Matt Fisher, a senior research fellow with the University of Adelaide’s Stretton Institute, told The Guardian that Australia’s high use of antidepressants “constitutes a failed attempt to medicate away what are, in fact, social problems”.
He said while “antidepressants may be of benefit to some people suffering persistent psychosocial distress,” they should not be the default, first response.
Chronic stress, where people are exposed to an ongoing, recurrent stressor without any easy or accessible way to resolve it is a significant driver of mental distress in Australia, including depression and anxiety, Fisher says.
Fisher argues that current policies in Australia are contributing to these toxic social conditions causing chronic stress and this kind of stress cannot be medicated away. Medical and pharmacological-focused solutions might be helpful for some but do little to help with the kind of chronic stressors that drive ill health, he says, such as toxic workplaces or insecure housing.
“The most effective, long-term response to epidemics of psychological distress is to adopt a public health approach to wellbeing promotion,” Fisher says.
‘The most effective, long-term response to epidemics of psychological distress is to adopt a public health approach to wellbeing promotion.’
AUSTRALIA
Our creaking health system needs reform
The federal election is done and dusted but there are worrying signs about our health system that remain and demand reform, health leader Stephen Duckett told The Conversation. Any fresh reform agenda will be starting from a position of relative strength, he says.
“Australia has a good health system that consistently ranks well compared with other wealthy nations – including on life expectancy, which is on the high side.
“Medicare remains the right infrastructure for funding primary care. But it is now more than 40 years old and needs to be updated and improved.”
Policy action, Duckett said, is necessary on five fronts:
• financial barriers to care
• managing chronic conditions
• mental health and dental care
• public hospitals
• the workforce.
There has been inadequate funding of public hospitals by the federal government, Duckett says.
“The commonwealth share of public hospital funding has been trending down for the last few years, reversing the growth in its share over much of the last decade,” he says.
In 2014, the Abbott government abolished Health Workforce Australia, the national agency responsible for health workforce planning. Ten years later, Duckett says, it’s no surprise we are in the middle of a critical shortage of doctors and nurses.
“Ensuring we have the right workforce mix to address rural health needs requires a fresh approach. That includes revised funding models – as proposed in the GP incentives review – and allowing all health professionals to work to their full scope of practice,” he said.
‘The commonwealth share of public hospital funding has been trending down for the last few years’
Stephen Duckett
AUSTRALIA
One third of cancer patients from migrant backgrounds at risk of harm
Miscommunication is a key factor for patients from CALD backgrounds being at risk of harm from problems such as contracting a hospital-acquired infection or medication errors.
In a recent study researchers from Macquarie University, UNSW Sydney and The University of Melbourne found CALD (culturally and linguistically diverse) cancer patients in Australia had roughly a one-in-three risk of something going wrong during their cancer care.
“This is unacceptably high,” they wrote in The Conversation.
Their study reviewed a total of 628 medical records of CALD cancer patients. They found 212 of the 628 had at least one patient safety event recorded. They also found 44 patient records had three or more safety events recorded over a 12-month period.
Medication-related safety events were common, such as the wrong medication type or dose being given to a patient. Sometimes the patients themselves took the wrong type or dose of a medication or stopped medication all together. They also observed a variety of other patient safety events such as falls, pressure ulcers and infections after surgery.
The researchers identified miscommunication from language barriers or health literacy issues as a key factor.
By comparison, studies over many years indicate an average one in ten of all patients admitted to hospital have experienced a safety event.
More than 7 million people in Australia were born overseas. Some 5.8 million people report speaking a language other than English at home.
A one-in-three risk of something going wrong is unacceptably high.
AUSTRALIA
Better cleaning of hospital equipment cuts patient infections – and saves money
Researchers from the University of Newcastle and Monash University have shown that regularly disinfecting shared medical equipment can help reduce infections picked up in hospitals – and save the health system money.
In Australia, there are an estimated 7500 deaths associated with hospital-acquired infections annually. The most common include wound infections after surgery, urinary tract infections and pneumonia.
Research suggests medical equipment (such as blood pressure machines, dressing trolleys and drip stands) could be a common source of infection.
The Newcastle and Monash researchers conducted an experiment – known as a “stepped wedge trial” in a New South Wales hospital where they introduced a package of extra cleaning measures onto several wards.
The package consisted of designated cleaners specifically trained to clean and disinfect sensitive medical equipment. Normally, the cleaning of shared equipment is the responsibility of clinical staff.
They claim cleaning thoroughness improved from 24 per cent to 66 per cent after the introduction of the package and hospital-acquired infections dropped from 14.9 per cent to 9.8 per cent of patients.
“This not only benefits patients, but also hospitals and the community, by freeing up resources that can be used to treat other patients,” they wrote in The Conversation.
“We estimated the 30 fewer infections per 1,000 patients reduced costs to $1.5 million, even when factoring in the cost of cleaners and cleaning products. Put differently, our intervention could save a hospital $642,000 for every 1000 patients.”
WORLD
A crisis in wellbeing among the young
UN-commissioned study in UK, US, Ireland, Australia, Canada and New Zealand finds a mental health crisis that means “youth is no longer one of the happiest times of life”.
In a research paper commissioned by the UN, leading academics Jean Twenge and David Blanchflower warn that a burgeoning youth mental health crisis in six English-speaking countries worldwide is upending the traditional pattern of happiness across our lifetimes.
Whereas happiness was once considered to follow a U-shape – with a relatively carefree youth, a tougher middle age and a more comfortable later life – wellbeing experts now suggest life satisfaction rises steadily with age instead.
“The U-shape in wellbeing by age that used to exist in these countries is now gone, replaced by a crisis in wellbeing among the young,” according to the paper published by the US National Bureau of Economic Research.
The study found that life satisfaction and happiness has fallen among young people over the past decade, and particularly among young women.
It highlighted the rise of smartphones and social media, suggesting the trend coincided with the growth of internet usage.
“The young have become isolated. It’s also not so much that people are sitting there on the phone, it’s what they’re not doing. They’re not going out as much; playing with their friends, interacting with others, or having as much sex,” Blanchflower, a former Bank of England policymaker told The Guardian.
"I don’t think there is any doubt you have an absolute global crisis. Young people are in deep disarray and trouble.”
“(The young are) not going out as much; playing with their friends, interacting with others, or having as much sex.”
— David Blanchflower
Our intervention could save a hospital $642,000 for every 1000 patients.”
health+wellbeing
The importance of exercise
As health professionals, nurses, midwives and students know the value of patients maintaining their level of physical activity. It is equally important to care for your own physical health. Here are some of the benefits of exercise and how to get moving.
Keeping active
Exercise and physical activity are beneficial for all ages and stages in life, but in a physically intensive profession like nursing and midwifery, it is most important to look after your physical health. Keeping active also helps to maintain and improve your psychological and emotional health.
What suits you
Look for a physical activity that you enjoy and are motivated to keep doing. Department of Health and Aged Care guidelines for adults 18–64 suggest 150–300 minutes/week of moderate exercise such as:
• walking
• swimming
• yoga or pilates
• mowing the lawn even Or 75–150 minutes/week of rigorous exercise such as:
• dancing/aerobics
• running
• fast cycling
• team sports such as netball, basketball or soccer Start slowly to build up your resilience. If you haven't exercised much recently speak to a doctor about how best to get started.
Increasing your fitness
As your physical health improves it's a good idea to vary the type of activities:
• Strength and resistance training – improves muscle and bone strength
• Flexibility exercise – improves joint and muscle range of motion
• Cardiovascular exercise/aerobics training – improves physical endurance and personal stamina
• Balance/core workouts –improves balance and co-ordination and increases abdominal strength
Feeling good
No matter the exercise, you benefit as it triggers the release of 'feel good' chemicals from your brain.
• Serotonin – reduces depression and hostility and improves agreeable social behaviour
• Dopamine – improves mood and long-term memory
• Endorphins – produce a euphoric or 'natural high' response. They also act as an analgesic, diminishing the perception of pain, and as a sedative.
Other benefits of exercise
• reduces the risk of depression and/or anxiety
• helps improve mental health
• improves mood and concentration
• reduces stress
• reduces the risk of dementia and Alzheimer’s disease
• reduces the risk of osteoporosis and improves bone density
• improves immunity
• improves sleep quality
• helps maintenance of weight/ weight control
• reduces the risk of cardiovascular disease, stroke and type 2 diabetes
• lowers the risk of some cancers
• assists with pain management
More information:
Department of Aged Care guidelines on physical activity https://www.health.gov.au/topics/ physical-activity-and-exercise/ physical-activity-and-exerciseguidelines-for-all-australians/ for-adults-18-to-64-years
WHO infographic on physical activity https://www.who.int/ multi-media/details/ who-guidelines-on-physicalactivity-and-sedentary-behaviour
Need support? Get in touch
Nurse and Midwife’s Support provides free and confidential support 24/7, to nurses, midwives and students Australia wide. If you would like to speak to someone call 1800 667 877, or you can request support via email (https:// www.nmsupport.org.au/support).
SCHOLARSHIPS
APPLICATIONS CLOSE 5PM ON 31 JULY 2025
nswnma.info/edith-cavell
Applications for the Edith Cavell Trust Scholarships are being accepted from 1 May 2025, closing 31 July 2025, for studies being undertaken in the academic year 2026.
Members or Associate Members of the NSW Nurses and Midwives’ Association or the Australian Nursing and Midwifery Federation (NSW Branch) are invited to apply.
All grants, awards or loans shall be made to financially assist nurses, midwives, assistants in nursing, assistants in midwifery (including students of those disciplines), and accredited nursing or midwifery organisations, schools and faculties in the furtherance of:
(i) accredited nursing or midwifery studies;
(ii) such academic research programs as are approved by the Trustees in the theory or practice of nursing or midwifery work; or
(iii) clinical nursing education programs at graduate, postgraduate and continuing education professional development level; in accordance with a number of categories.
Full details of the scholarship categories are available from the NSWNMA website. The scholarship application process is now online. Please ensure you have read the Edith Cavell Trust Scholarship Rules and have all your supporting documentation compiled prior to commencing the online application process.
For further information contact: Scholarship Coordinator, The Edith Cavell Trust T 1300 367 962 E edithcavell@nswnma.asn.au
test your Knowledge
ACROSS
1. Condition where the body attacks itself (10.7)
10. Tarsus (5)
11. Pain following shingles infection (1.1.1)
13. Young wild animal (3)
14. In its original state (9)
15. Hamuli (5)
16. In a straight upright position (7)
17. Thickened skin (7)
19. Prana, chi, vitalism (9)
21. A type of obstetric forceps (7)
22. Negative response (2)
23. Contraceptive device for women (8.3)
25. Relating to sound waves (5)
27. Drug that reduces immune response (17)
31. Intermittent and involuntary (9)
33. Cause anxiety or concern (7)
34. Aged (3)
35. Wound dressing (7)
37. Fold in a membrane or tissue (5)
38. Cognitive disorder linked to alcohol use (8'1.8)
DOWN
1. Severe allergic reaction (12.5)
2. Lift-off (7)
3. Intestinal blockage (5)
4. Bones in the hand (10)
5. Not able to extend or collapse (13)
6. Make sad or downhearted (7)
7. Fibrous joint connecting bones (11)
8. Abnormal accumulation of fluid in the abdomen (7)
