The Lamp: October - November 2025

INFLUENCE FOR CHANGE

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NSW Nurses and Midwives’ Association

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Editorial Committee

Shaye Candish, NSWNMA General Secretary

Michael Whaites, NSWNMA Assistant General Secretary O’Bray Smith, NSWNMA President

Michelle Cashman, Long Jetty Continuing Care

Michelle Cutler, Tweed Hospital

Karen Hart, Wagga Wagga Base Hospital

Robyne Brown, Maitland Hospital

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The Lamp is the official magazine of the NSWNMA. Views expressed in articles are contributors’ own and not necessarily those of the NSWNMA. Statements of fact are believed to be true, but no legal responsibility is accepted for them. All material appearing in The Lamp is covered by copyright and may not be reproduced without prior written permission. The NSWNMA takes no responsibility for the advertising appearing herein and it does not necessarily endorse any products advertised.

Authorised by S. Candish, General Secretary, NSW Nurses and Midwives’ Association, 50 O’Dea Avenue Waterloo NSW 2017

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VOLUME 82 NO. 5

COVER STORY

Member activism hits new heights

Sustained membership action over pay, staffing and other conditions puts employers under pressure.

14 COVER STORY Minister Park announces Chief Midwife role for NSW

Ryan Park promises to adopt a recommendation made in several reports and create a position that will provide leadership in maternity and birthing services.

16

PHS PAY CAMPAIGN

Members approve interim pay and penalty increase

Members have voted to accept an interim pay rise while the Industrial Relations Commission hears our case for a bigger increase.

20

PROFESSIONAL DAY

A new frontline role for nurses and midwives

Hope for a healthier planet and a sustainable future is built on action and solidarity, says Catelyn Richards.

22

HEALTHSCOPE

NSWNMA fights for Healthscope jobs and entitlements

The NSWNMA is fighting to protect the jobs and entitlements of members employed by Healthscope hospitals.

30 PROFESSIONAL ISSUES

NSWNMA acts on racism survey

The Association will work with the Australian Human Rights Commission and employers to combat racism in the health and aged care sectors.

by Sharon Hickey

SHAYE

Candish

GENERAL SECRETARY

Influence for change

Annual conference is an occasion to celebrate our wins and progress as a union and an opportunity to reflect and to reset in order to meet the existing and coming challenges.

We have not won all the things we have fought for this year but there has been plenty to celebrate. We have had a mammoth year together with tremendous campaigns on all fronts.

This year’s annual conference theme Influence for Change signalled how we, as nurses, midwives and carers, are at the forefront of change in health.

Let’s briefly restate some of the memorable achievements of the past year.

The successes on gender reform are worth highlighting. The NSWNMA and the Teachers Federation fought hard for, and won, changes to the NSW IR Act which are among the most significant improvements in workplace rights in 30 years.

These changes aim to achieve gender equality in the workplace and to achieve equal renumeration for men and women doing work of equal or comparable value and to eliminate the gender-based undervaluation of work.

In the public health system and in private hospitals there has been record breaking and historic industrial action by members fighting for improvements to pay and conditions.

In aged care it has been another big year, considerable progress has been made, and reform is moving in the right direction after decades of neglect.

As a union if we can deal with pay, with flexibility and with workloads we’ll be in a position to genuinely address burnout.

OUR HISTORIC SPECIAL CASE BEGINS

As The Lamp goes to print, we are embarking on one of the biggest legal cases in living memory in the New South Wales Industrial Relations Commission on behalf of public sector nurses and midwives throughout the state.

Our comprehensive case aims to increase wages by providing evidence that shows the impact of:

• the gendered undervaluation of the work you do

• the work value increase over the past 16 years

• the impacts of productivity and inflation; as well as

• recruitment and retention across the Public Health System.

After rejecting the government’s 3 per cent per year over three years offer, we made the case for:

• a 35 per cent pay increase over 3 years

• Sick Leave to increase to 20 days, and

• a meal allowance for Patient Transport Services.

We have been meticulous in the preparation of the case. Our evidence amounts to a total 17,451 pages - 7,739 pages of expert evidence and 9,712 pages of member evidence.

We expect the hearings to last six weeks with an outcome in 2026.

THE CHALLENGES GOING FORWARD

Our special case in the IRC is a major initiative to deal with the issue of pay but there are other obstacles to building a sustainable public health system.

We have commissioned research by eminent academics to explore different forms of flexibility of work that nurses, midwives and carers want.

As a union if we can deal with pay, with flexibility and with workloads we’ll be in a position to genuinely address burnout.

The recent Standing Together Against Racism report (see p26) confronts us with another challenge that we must all meet together – racism in the workplace.

The report found a staggering 64 per cent of nurses, midwives and AiN/ care workers from a culturally and linguistically diverse or Aboriginal and Torres Strait Islander background had been a victim of racism.

This is unacceptable and the NSWNMA is committed to collaborating with other key stakeholders to improve education and reporting around this issue in order to create safer workplaces for all our members.

WE NEED TO BE AMBITIOUS

By working together, we have achieved incredible things this year. We’ve campaigned like never before. We’ve raised our voices like never before. And we’ve showed our strength like never before.

We need to set the bar high and be ambitious. Our goal is for workplaces that provide better job control, where gender equality exists and where governments and employers respect and value the work that you do.

Let’s move forward with passion and determination to create a better future for nurses, midwives and carers.n

Have your Say

Featured Letter

If you’re an EN, join us!

I am an EN, Branch Official and a union delegate, and I have been advocating for enrolled nurses (ENs) to have a voice in healthcare policies that directly affect us. Working with the Association, we’ve now established an Enrolled Nurse Professional Reference Group.

I'm hopeful for the future of ENs as this reference group gears up to make some real progress. We'll be meeting regularly to talk through the issues that directly impact the EN workforce, digging into NSWNMA policies and statements to see how we can build on what's already there, and, just as importantly, to create a safe space to share our ideas on what the future could mean for us.

I have first-hand experience as an EN: we are often overlooked compared to RNs - this is the unfortunate reality. Most ENs choose this profession because we want to make a difference in people's lives, to care for people and look after patients. But often, bias in the workplace makes it difficult for us to perform our jobs to the best of our ability.

What I am hoping to gain from being a member of the EN Professional Reference Group is to help shape a future where ENs have a seat at the table and a voice in conversations that matter the most to them. If you’re an EN, I hope you join us!

Ciaran McCloughan, EN, Ryde Hospital & Community Services

Opal aged care residents deserve better

Even though the Federal Government made it compulsory for every aged care resident to receive a minimum of 215 minutes per resident, per day from October 2024 (delivered by AIN/PCW/RN/EN), most nurses feel that the staffing numbers on floor have shrunk, placing even more pressure on nursing and caring staff.

It's common to see nurses and carers being directed to wash dishes, empty bins, fold linen and serve trolley meals because management has cut jobs in other areas! Most nurses feel the pain of understaffed rosters, which means we never have enough time to care for our residents.

We feel Opal is lacking in transparency on how they record nursing staff care minutes. As a union, we have taken Opal to the Fair Work Commission to force Opal to show how care minutes are recorded.

We are having this fight to prove that their system is not working and that they are not allowed to cheat the system. Nursing staff should be there to look after residents only,

not asked to go into the kitchen or laundry because Opal refuse to hire enough staff.

Opal's priority should be to make sure they have enough staff in every department, so residents’ needs are well looked after. These residents, or "consumers" as Opal like to call them, are paying for that and it is a substantial amount of money. They deserve better and we won't stop fighting until we win!

Samantha*, AIN, Opal Specialist Aged Care (*name changed to protect member identity)

Systemic response needed against workplace racism

I am a registered mental health nurse who is member of the amazing NSWNMA CALD (Culturally and Linguistically Diverse) Reference Group. The recent Standing Together Against Racism report shows alarming evidence that more than two thirds of nurses and midwives self-identifying as CALD have suffered racism in the workplace. This is unacceptable.

The NSWNMA denounces racism. Racism negatively affects people in all aspects of their lives, leading to poorer outcomes physically, mentally, academically and socially. It is a public health issue and burden. The Australian Human Rights Commission is working on delivering “a new and stronger antiracism campaign”.

So, what can we do? If we keep doing the same things, outcomes will not only remain the same but will get worse. Racism deeply harms people on a personal level and a whole of system response is crucial if we want to see meaningful change.

Things to reflect on and respond to where we can make a difference:

• Policy makers: Are our anti racism policies current and responsive to the needs of those likely to experience racism?

• Organisations and leaders: How well are anti-racism policies understood, safely reported, and supported through culturally responsive practices and education?

• Individual nurses and midwives: How can I be a safe and effective ally in the workplace without fear of repercussions?

• Nurses and midwives likely to experience racism: Have I experienced racism, and do I know how to report it and access support safely? (The NSWNMA can guide you through this process).

Nurses and midwives lead with compassion and trust. Let's use our influence to drive real change against workplace racism.

Julie Ngwabi, RN

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Featured Letter

Nerves and excitement becoming an RN

Recently, I applied and interviewed for new graduate registered nursing positions in the public health system. This experience marked a significant milestone in my journey to becoming an RN and explicitly highlights almost the end of my three-year journey as a student nurse.

Whilst I am excited to join the nursing workforce, I am now nervously awaiting to hear if I will be successful in getting a position. I spent many hours lamenting over the application requirements, such as various types of documentation and paperwork I needed to supply. Further, the heavy decision of choosing your top 6-8 hospital/health service/MPS or LHD preferences for your first year as an RN was one that I did not make lightly.

Once 11:59 pm on the 30th of June rolled around and applications closed, I was temporarily relieved. I had made my decision about preferences and felt a sense of excitement for what was to come in the GradStart application process.

This sense of relief dwindled as my August interview approached.

If there’s something on your mind, send us a letter and have your say. You could

Although well prepared, I knew that I would still heavily criticise myself afterwards. So, I leaned on both my nursing and social support systems for guidance throughout the days leading up to my interview. Then on the 21st of August, my interview was over. All the stress and worry were gone.

It’s been two weeks since my interview, and I can say with certainty I am both nervous and excited for the 14th of October!

Lucy Pike, Student RN, Western Sydney University

The struggle to find affordable housing

Finding affordable housing in regional NSW hasn’t been smooth. I had no knowledge of the steps needed to obtain accommodation and no family or friends that could help me, after moving to Wagga from New Zealand to take up an agency nursing position.

I have been in Australia for just over a year now working as a paediatric nurse, resulting in me being away from my children and partner for long periods at a time, which has been difficult. It was overwhelming

and nerve wracking to find accommodation that was near work and within my budget. I started searching for a home once I accepted a permanent position and was told that I had less than four weeks left at the nursing accommodation I was staying at. I was not prepared for the amount of stress that would follow.

I had applied for many homes and attended a few viewings at a time that did not interfere with my work hours. Time was running out so in a moment of desperation I applied without viewing the properties and accepted the conditions as seen on the advertisement.

After many setbacks, I have now found a place to call home, but on my wage, it means around 48 per cent of my weekly pay goes towards rent which, doesn’t leave much leftover once all other bills are paid. If I could describe the struggle of trying to find affordable housing in a couple of words, it would be rejection and upsetting.

Tana Shelford, EN, NSWNMA Wagga Wagga Hospital Branch

Member activism hits new heights

Sustained membership action over pay, staffing and other conditions puts employers under pressure.

An unprecedented level of membership involvement in NSWNMA activity has kept pressure on the state government and non-government employers to value and properly reward nurses, midwives and carers, General Secretary Shaye Candish told Annual Conference.

“This union has campaigned for change like never before in the past 12 months. We have truly taken our member-led collectivism to new heights,” she said.

“In the public sector, we turned out almost 10,000 nurses and midwives onto the streets of Sydney on two occasions, in a union feat no one has seen in five decades – maybe not ever.

“Members organised in workplaces, you mobilised colleagues, you refused to surrender to the bullying and the intimidation tactics of your employer and you fought back in a public display of courage and strength.”

Shaye also praised nurses and midwives who took part in regional actions and those who supported their striking colleagues by “staying behind to keep hospitals and health facilities open and running”.

“It was a true testament to the sheer determination, persistence and passion you all have in righting the wrongs of a decade of wage suppression.

“Despite the government’s best attempts at ignoring our demands there is no denying that community

“Despite the government’s best attempts

at ignoring

our

demands

there

is no denying that community support for nurses is deep seated and widespread.”

— NSWNMA General Secretary Shaye Candish

support for nurses is deep seated and widespread.”

Following the industrial action, members had kept up the pressure on decision makers with owntime rallies, raising community awareness, sitting in the public gallery at parliament and meeting with local MPs.

“Almost 22,500 digital actions have been taken, including emails to the NSW Treasurer and local MPs, phone calls to politicians, and members sharing stories from the frontline of our healthcare system.

“It is this sustained action and your sheer determination that has led to the government putting an interim offer to you.”

3.7 PER CENT GROWTH LAST YEAR

Shaye said NSWNMA membership has reached almost 82,000 after growing by 3.7 per cent in the past year – “something that other unions just dream of”.

The private sector had also seen “record breaking and historic” industrial action by members fighting for better pay and conditions.

Shaye congratulated members at Ramsay who secured “a landmark new enterprise agreement” in April.

“After more than 250 days of sustained protected industrial action including more than 60 strikes, 21 bargaining meetings and three successful No votes, members were able to shift their employer and receive a pay deal that was double the initial offer.”

Shaye also congratulated members at Healthscope who held a series of “historic” strikes for ratios and better pay.

Financial mismanagement and corporate greed sent Healthscope into receivership and its Northern Beaches Hospital, which is run as a public-private partnership, was the subject of a damning NSW auditor general’s report.

“This union has long been opposed to the public-private partnership model at Northern Beaches and finally it feels as though the tide is turning on this,” Shaye said.

“I would like to particularly acknowledge our branch and members who have continued to show up to work every shift and deliver the best quality care to patients despite the intense scrutiny and pressure.”

Shaye also acknowledged how members had helped to win $4.5 million in back pay for hundreds of nurses and midwives at St Vincent's Private.

“Local branch leaders played a crucial role in detecting errors in the way certain entitlements were applied,

Democracy vital for a strong, united union

The NSWNMA has grown to become the 10th largest union in Australia, Assistant General Secretary Michael Whaites told Annual Conference.

“Australia’s nursing and midwifery unions are continuing to grow: One in five trade unionists in this country is a nurse or a midwife,” he said.

“While our membership growth is strong, we must ensure we are providing services and support to members and that includes supporting branch officials and delegates and your branches.”

Michael said the NSWNMA is revamping its trade union training courses with new course content including online and face to face training opportunities.

He said leaders of all unions “must be held accountable for the actions we take on your behalf, and accountability requires strong democratic structures”.

“While we have one of the most democratic structures in the union movement we must not rest on what we have always done.

“That means being open to exploring new ways of doing things.

“We have listened to delegates and explored our organising resources and our voting systems.

“The resulting reports help us to respond to your needs and we welcome that process.”

Michael said the cornerstone of being a strong united union is “the ability for members to meet in their workplaces and bring the voice of their members to this annual conference to help shape our direction and our democracy”.

“Issues need to be discussed, investigated and resolved for the betterment of the union and I'm proud that our union has both the democratic structures and processes to do this crucial work together.”n

and advocating for the interests of members and maintaining regular dialogue with hospital management to ensure a fair outcome was achieved.”

Shaye reported that the aged care sector is continuing to reform in the right direction after decades of neglect.

“Thank you to our aged care delegates and members who are stepping up, speaking out and making a difference in their workplaces day and night.”n

“While we have one of the most democratic structures in the union movement we must not rest on what we have always done.”

— NSWNMA Assistant General Secretary Michael Whaites

Members ask ministers to listen, commit and act

The NSW Minister for Mental Health and Minister for Housing Rose Jackson and the Minister for Health Ryan Park heard from several of our members at Annual Conference as they reported from the frontline of a system in crisis. The ministers were then asked to commit to a collaborative process that aims to improve our ailing health system.

Mental health nurses need better training

“I’ve worked as a mental health nurse in NSW for almost 10 years, and in that time I’ve seen a real shift in the preparation of new staff entering the field,” Mental Health CNC Damon McKenzie told the Minister for Mental Health Rose Jackson.

“What most mental health nurses learn when it comes to treating patients with major mental illnesses is ad hoc. It depends entirely on where they start and who is there to teach them. Without training I see poor practice, and sometimes the wrong practice. These are practices that aren’t evidence-based, ethical or safe.

“They were failed by a system that isn’t training people enough.”

“I’ve worked with both new starters and senior nurses who lacked the fundamentals of mental health nursing. That is, recognising deterioration, understanding behavioural escalation or knowing how or when to intervene.

“I saw this play out during an incident at one of the inpatient units where a patient, who had been visibly escalating for hours,

ended up setting a bonfire in the courtyard of the mental health unit, using hospital linen. The warning signs were there. Staff had even documented them, but without proper training, they didn’t recognise the signs for what they were.

“When the fire was lit, staff stood back, waiting for instructions, unsure what to do. It was a security guard who eventually entered the unit and put the fire out. The patient was injured. That injury didn’t happen because staff didn’t care. It happened because they weren’t equipped. They were failed by a system that isn’t training

people enough and in turn the system failed the patient.

“And those of us working with these people, every day, know just how much that matters.”

MENTAL HEALTH CNC WARREN ISAAC’S QUESTION TO THE MINISTER FOR MENTAL HEALTH:

“Will you commit to resourcing a working group with the NSWNMA to develop and implement a standardised mental health specialty training pathway for nurses, recognised across all Local Health Districts and accessible via the HETI platform – with a draft for consultation within 12 months and implementation readiness within 18 months?”

MINISTER JACKSON’S REPLY:

“Yes, I will. I’ve been told that there is a mental health pathway in practice module that HETI runs. Clearly that is not hitting the mark. That’s not acceptable to me. We’ve already initiated a process to revise that. I can give you a commitment: Yes, we can and that timeframe is reasonable. And yes, I will ensure delegates nominated by the NSWNMA are active and full participants in that working group.”n

MENTAL HEALTH CNC DAMON MCKENZIE

Private sector nurses need affordable housing too

“I work in residential aged care on the Northern Beaches, where I’ve cared for residents like Jennifer, Michael and William for years,” RN Sabita Chaudhary Khatiwada told the Minister for Housing.

“I love seeing them every day – it’s the best part of my job. In this role, I get to support people with dignity, build trust, and be there in some of the most important moments of their lives.

“But I can’t afford to live anywhere near my workplace. I travel from my home where I live in Campsie – over 30 kilometres away. It often takes me one-and-a-half hours each way, longer in traffic. I’m lucky – most of my shifts are eight hours long, but colleagues who work in other residential homes tell me they work six-hour shifts, and they spend half that time commuting. The cost of fuel, tolls, and car maintenance is a huge expense for my family. I often work double shifts so driving in the dark, when I’m exhausted, isn’t safe for me. Public transport would take me over two hours each way –walk, bus, train, bus, walk again. Some of my colleagues do that every single day.

“The cost of fuel, tolls, and car maintenance is a huge expense for my family. I often work double shifts so driving in the dark, when I’m exhausted, isn’t safe for me. ”

— Sabita Chaudhary Khatiwada

“I know I speak for many Registered Nurses, Enrolled Nurses, Carers and student nurses working in private aged care and hospitals. We are essential – but we’re often left out of essential worker housing schemes. As private sector workers, we’re excluded from policies that could help us to live closer to the people we care for.

“We don’t want to leave jobs we love or our patients who we’ve built relationships with. We’re asking you to think about us in your housing decisions - so we can keep doing the work that matters, with the people who matter.”

NSWNMA COUNCILLOR

SHERIDAN BRADY’S QUESTIONS TO THE MINISTER FOR HOUSING:

Q1: “Will you commit to change the NSW Affordable Housing Ministerial Guidelines so that essential worker housing is clearly included in the definition of affordable housing, with eligibility criteria that reflect the true cost pressures on nurses, midwives, and carers – such as ensuring housing is considered unaffordable when rent exceeds 30 per cent of their income – so they are guaranteed fair access to affordable housing?”

Q2: “Will you also ensure that all nurses, midwives and carers in NSW who are in need of support to access secure housing, whether public, private, primary or aged care, are eligible for essential worker housing, as recommended by the upper house inquiry?”

MINISTER JACKSON’S REPLY:

“The answer again is essentially yes. The ministerial guidelines for affordable housing are currently under review. The intention is to update them, to reflect exactly the points that you have made. I recognise those guidelines have been too narrowly construed and lots of people such as yourself have been excluded from that. They are under review, and we will ensure that they capture all those essential workers you have described not just public sector workers but also those working for community organisations or private aged care providers. It will also include people working in childcare or other professions.

“That will not ensure access to housing. We can update the eligibility but the work that we have to do to build the housing so that you are just not sitting on a list is just as important. But the first step is that eligibility question and we will get that updated.”n

RN SABITA CHAUDHARY KHATIWADA

Student midwives are being hung out to dry

“I returned to work this February after having a year off for maternity leave. On my third shift back, I found myself supporting a junior, casual pool midwife on her second in-charge shift,” Clinical Midwifery Educator Emma Kingi told the Minister for Health Ryan Park.

“As the most experienced person on shift I was working with:

• a new graduate midwife who had just registered in mid-February

• two overseas-recruited midwives who had commenced their placement with us in January

• two postgraduate students transitioning to become registered midwives.

“That’s four midwives who need support and two students unable to provide care by themselves. We looked after seven labouring women and a day full of pregnancy assessment walk-ins. Skill mixes

like this are unsustainable but are considered acceptable under the Birthrate Plus workforce planning tool.

“Last month, on another juniorheavy shift, I responded to a rapid response call. A woman was rushed to an emergency caesarean following an abnormal ultrasound. One of our new grads went with her as her midwife. Tragically, at two-hours old that baby passed away. She asked me if she’d missed something, worried that her inexperience had somehow contributed to this baby’s death. If only proper staffing allowed her to be supported like she needed.

“It's not fair to students, who often say the Midstart year is the worst and hardest year of their career – so hard, many don’t finish.

“It’s not fair to midwives and educators already overrun and forced to pick up those shortfalls.

“It’s definitely not fair to the women and babies who don’t receive the care they deserve.

“My nan was an AIN, my mum a nurse and midwife just like myself. I have a four-year-old niece. I asked mum if she’d encourage her to go into nursing. She said no. And frankly neither would I.”

NSWNMA COUNCILLOR EMMA GEDGE’S QUESTION TO THE MINISTER FOR HEALTH:

“Minister, will you commit to recommencing the review of the workplace planning tool Birthrate Plus, beginning with a focus on improving the experience of student midwives – including properly considering their removal from Birthrate Plus workforce numbers – and to identifying a more suitable alternative?”

MINISTER PARK’S REPLY:

“Yes, we will. I’ve had concerns about this for some time – your issues around beginning midwives, student midwives. The issue of midwifery and birthing services across NSW, in particular in regional and remote areas, has to improve. We need to do better. I thank you for your advocacy today. What you talked about today is not easy, particularly as a health professional so committed as yourself. We are committed to reestablishing the working group and putting a focus on how we can do this better.”n

“It's not fair to students, who often say the Midstart year is the worst and hardest year of their career – so hard, many don’t finish. ”

— Clinical Midwifery Educator Emma Kingi

Our Public Health System needs a comprehensive workforce plan

“I work in a small rural MPS in Holbrook where there is no doctor on site most of the time. We only rely on the Remote Medical Consult Service – a voice on the end of the phone – to support patients who may never physically see a doctor,” RN Jodie Beattie told the Minister for Health Ryan Park.

“But even that lifeline is unreliable. Phone lines drop out regularly, and recently we had no phones or Wi-Fi for over a week. Great in a resus situation.

“We’re critically understaffed. On night shifts we often have just three staff – one RN managing ED, acute, and aged care – sometimes responsible for 27 patients. We have no security onsite. One night a patient’s behaviour escalated. He shadowed me, threw objects and broke window locks to try and escape. I was told by security they’d ‘see what they could do’. No one

“Nurses are exhausted. We’re stretched beyond safe limits. And unless something changes, we won’t just walk away –we’ll run.”

— RN Jodie Beattie

turned up. I spent the shift locked in the nurses’ station, afraid to answer bells. At one point, I even lost track of him – he was hiding in a dark corridor. I was terrified.

“Management says: ‘just call someone in’ But when no one comes – you stop calling.

“Now Murrumbidgee Health plans to cut four hours of nursing care per shift, saying there’s ‘not enough activity’ – despite already failing to meet the Award’s requirement of two RNs in ED. Your commitment was to lift it to three.

“Instead, we’re being told to take on non-nursing tasks like cleaning toilets. Really!

“Nurses are exhausted. We’re stretched beyond safe limits. And unless something changes, we won’t just walk away – we’ll run.”

NURSE UNIT MANAGER KRISTYN WILSON’S QUESTION TO THE MINISTER FOR HEALTH:

“Will you commit to a workforce planning summit with the NSWNMA by mid-2026, bringing together key stakeholders and establishing a joint working group to develop a comprehensive 5- and 10-year plan that ensures that every community in NSW has access to the skilled nurses and midwives they need, now and into the future? Because Minister Park we certainly don’t have this now.”

MINISTER PARK’S REPLY:

“Yes, I can in relation to the summit. Not only am I prepared to have that sort of forum and a summit, but I think we also need to be ready to build the next component of ratios going forward and that will be a discussion we have with you over the next little while.

We’ve got a long way to go but I can assure you while I’m your health minister the workforce will remain my absolute top priority.”n

Minister Park announces Chief Midwife role for NSW

Ryan Park promises to adopt a recommendation made in several reports and create a position that will provide leadership in maternity and birthing services.

Earlier this year a major report on the midwifery profession found that more than a third of midwives surveyed were considering leaving the profession due to poor working conditions.

The report, Midwifery Futures, found there were not enough midwives or current midwifery students in the pipeline to meet our future needs.

It found New South Wales had the lowest number of midwives in the country. The report’s authors emphasised that “strong and skilled midwifery leadership was essential for developing the future midwifery workforce”.

At Annual Conference, the Minister for Health Ryan Park, made a significant announcement to meet this need.

“Today I have decided that in NSW we need to move towards establishing a Chief Midwife officer in NSW Health.”

“This [decision] came out of the Birth Trauma Inquiry, but to be blunt it’s been a conversation that you, your Association, and you as members and midwives have been having with me for possibly three to five years.

“For some time, I have been worried about maternity services and birthing services across NSW health and hospital facilities.”

— Minister for Health Ryan Park

“For some time, I have been worried about maternity services and birthing services across NSW health and hospital facilities.

“I want this to be a focus of the work we do, and I want to improve the care we provide to mums and bubs right across NSW.”

NSWNMA Assistant General Secretary Michael Whaites responded positively to the minister’s announcement saying “report after report” had emphasised the need for midwifery leadership in the system.

“At a time when our profession is under such immense pressure it is absolutely critical, and we thank you for that.”

“We know there have been national reviews of the workforce. What we need to do is look at the recommendations that are already out there and how we can get them

implemented. We look forward to doing that work with you.

“Every shift midwives hear ‘you’ve got the numbers’ and they don’t. They’ve got RNs, they’ve got assistants-in-nursing, they’ve got student midwives. They get treated as a number. But when one of these women die or one of their babies die –they are not a number, they are burnt into our souls.”

RATIOS ARE STILL UNFINISHED BUSINESS

Minister Park said the fuller implementation of ratios “remains a piece of unfinished business for us”.

“We’ve now seen an additional 500 staff come into the system. Over 30 EDs now are recruiting or have ratios in place. We want to accelerate that as fast as we can and get it to more components in other areas of the hospital.”n

MINISTER FOR HEALTH RYAN PARK

Minister for Mental Health promises more engagement, better outcomes

In her address to annual conference Minister Jackson said feedback from NSWNMA members helps the government “to grow and improve”.

“It’s not just words but there are outcomes we can achieve when we work together. I’m deeply committed to that as an ongoing process in the mental health portfolio,” she told Annual Conference.

Minister Jackson pointed out that the Association had convened a group of delegates from across the state who she had engaged with regularly online.

“I have obtained so much valuable feedback from that. We aren’t going to grow and improve as a government without that honest feedback and collaboration. I am deeply committed in the mental health portfolio to continue to listen and to continue to engage.”

The minister cited examples where this sort of collaboration had led to concrete, positive outcomes.

Mental health nurses working at Westmead ED “had engaged through the Union with me on some serious safety and quality care issues in that space,” she said.

“Through the engagement with the Union and with those members we’ve been able to undertake a process that is delivering real change and real improvement. Now it’s one ward, in one hospital, in one LHD in the state but it is an example of where the Union identified a significant issue, it was brought to my attention, and we were able to intervene.

“We made an unannounced visit, I saw for myself what was happening on the ground and now we are close to an outcome where all parties agree that the quality of care and the safety of nurses on that site has significantly improved.

“We were able to intervene to make sure the Ministry and the LHD took it seriously and the outcome is a positive one.”

NSWNMA General Secretary Shaye Candish welcomed the minister’s “forceful commitments” to improving training pathways for mental health nurses (see pp 10) and to building more affordable housing for essential workers in her role as Minister for Housing (see pp 11).

“I’m sure you can appreciate we will hold you to them. We will follow up, but I appreciate your enthusiastic response,” she said.

“Through the engagement with the Union and with those members we’ve been able to undertake a process that is delivering real change and real improvement.”

— Minister

for Mental Health Rose Jackson

“It’s great to hear you are already reviewing some of the training pathways in relation to mental health and we really would welcome the opportunity to partner with you and with the Ministry as that new program is developed so we can see the implementation as soon as possible and really see the changes the members are calling for.

“We have been campaigning around affordable housing so having your strong commitment to addressing [the eligibility] guidelines is very welcome.”n

Members approve interim pay and penalty increase

Members have voted to accept an interim pay rise while the Industrial Relations Commission hears our case for a bigger increase.

NSWNMA members in the public health system will get a 3 per cent interim pay increase and higher penalty rates backdated to 1 July 2025.

Night shift penalty rates will increase from 15 per cent to 20 per cent.

NSWNMA public sector branches voted to accept an interim pay and conditions offer from the NSW government.

The offer was accepted by 88.2 per cent of participating branches with elected delegates.

IRC hearings on the unions special case for a 35 per cent pay increase over 3 years were due to start on 30 September and run for six weeks.

The Commission’s decision on the pay increase is expected in early 2026.

NSWNMA General Secretary Shaye Candish said the Association’s case for a 35 per cent pay increase over three years is one of the biggest industrial cases NSW has seen.

“We will present evidence around the gendered undervaluation of nurses and midwives’ work and the work value changes our professions have seen over the past 16 years,” Shaye said.

She said the government made the interim offer in recognition that nurses and midwives needed a wage increase before the special case is decided.

‘(The 20 per cent night duty penalty rate) is a really positive move that brings NSW into line with penalty rates paid to nurses in Queensland.’— Emma Ratajczyk, President, Armidale Community Health and Hospitals Branch

“Members have democratically voted to accept this interim offer, knowing that there is a long way to go before the pay dispute is settled.

“Nurses and midwives are struggling to pay their bills in this cost-ofliving crisis so any financial relief is welcomed, while we wait for the bigger decision on pay from the IRC. Improvements to rosters will also provide staff with greater worklife balance.”

The NSWNMA’s general counsel, Neale Dawson, said "The Association has put on some very compelling evidence from a wide range of very well-respected academics in relation to women’s wages and women's work and the undervaluation of that work.

"We hope that, for the first time, this undervaluation is not only recognised but resolved by the ultimate outcome”.

AN IMPORTANT INCREMENTAL STEP

Armidale Community Health and Hospital’s branch was one of the branches that voted to accept the interim offer.

Branch President Emma Ratajczyk said most branch members viewed the interim 3 per cent wage rise as “an important incremental step” towards a substantial pay increase via the union’s special case at the IRC.

“Most members did not like the idea that they would probably have to wait until early 2026 for any pay increase if they said ’No’ to the interim offer,” she said.

“Even though it’s only 3 per cent it’s still money in our pockets not the government’s pocket.

“Our wages and our workforce support communities. We are losing staff to the Commonwealth sector which pays higher wages, and across the borders. We need to improve PHS wages in NSW and this is just the start.

“Industrial change is incremental, and this is a positive change.

“No one else can do what we do.

Our work is not a list of tasks; it is intelligent, learned, holistic care and we need to attract the right sort of people to our profession. Quality wages are essential for that.”

Emma said the 20 per cent night duty penalty rate is “a genuine attempt to recognise the value of nurses and midwives as shift workers who provide 24-hour, personalised, care”.

“It is a really positive move that brings NSW into line with penalty rates paid to nurses in Queensland.

“In 2009 the union ran a case in the Commission seeking an increase to night duty penalty rates and got zero.”

‘Members have democratically voted to accept this interim offer, knowing that there is a long way to go before the pay dispute is settled.’ — NSWNMA General Secretary Shaye Candish

She said some nursing sectors would benefit from parts of the interim offer aimed at doing away with unfair rostering.

“We are rostered quite fairly where I work, but I personally know people at other hospital sites and jurisdictions where two days off in a row is not standard and night duty before annual leave is something that occurs far too often.”

The interim offer includes improved trade union rights, such as paid time for branch officials to represent members and half-hour orientation sessions to allow branch officials to brief new starters.

“Dedicated work time to participate in union work amounts to government recognition of the importance of professional advocacy for our 50,000 PHS nurses and midwives,” Emma said. n

Accepting the interim offer does not impact the union’s case for a bigger pay increase in the Industrial Relations Commission (IRC).

Interim offer – main points

3 A 3 per cent interim pay rise backdated to 1 July 2025

3 Night penalty rates increased from 15 per cent to 20 per cent backdated to 1 July 2025

3 Two consecutive days off each week unless you agree otherwise

3 You must be advised of roster changes and given a chance to raise any concerns before any change is made

3 No night duty immediately before you start annual leave unless you request it

3 Improved trade union rights, including better access to orientations for new staff. A full half hour will be provided to Association officials to present orientations

3 Eight hours of paid time every eight weeks for branch secretary, branch president and delegates to distribute NSWNMA materials and talk to employees.

Stronger union rights will improve workplace communication

The introduction of paid time for NSWNMA PHS branch officials will help to keep members informed about vital employment and workplace issues.

Gosford Hospital NSWNMA delegate Deearne Dobson thinks the public health system interim pay and conditions offer was “a good win for everybody”.

“It gets us a 3 per cent interim increase backdated to July 1, while we wait for the result of our special case at the Industrial Relations Commission, where we are seeking a 35 per cent increase over three years,” Deearne said.

“We also get a guaranteed increase in night shift penalty rates, which will make a significant difference to people such as me as I do 50 per cent night shifts.”

Deearne said all four NSWNMA branches on the Central Coast voted to accept the interim offer.

“The vote at Gosford Hospital branch was close while the others –Mental Health, Wyong and Woy Woy Hospitals – voted overwhelmingly in favour.

“I don’t think anyone is 100 per cent happy with the offer the government has put forward, but I think members who voted to accept it considered the information the union put out and decided they wanted the money now.

“Some who voted No may have misunderstood the situation and believed the interim offer was the final deal.

“Others didn’t want to accept the offer believing it just wasn’t enough.

“Our union was happy to act on our vote either way, but ‘accept the offer’ is what the members have voted for.

“Like other branch officials I go in to work on my days off to put up flyers and hand pamphlets around, or I do it before and after my shift.”

— Deearne Dobson

“Two people told me they voted No ‘because we’re worth so much more’. They had not understood that our special case at the IRC is still going ahead.

20 PER CENT NIGHT PENALTY RATES

“There was also some anger that we were accepting a 20 per cent night penalty rate when some other states get more.

“Yes, some other states do get a higher penalty rate but we are

dealing with NSW politicians not WA politicians.

“We went to the IRC in 2009 with a similar case and got no increase to night penalty rates.”

The interim offer includes an expansion of union rights such as eight hours paid time every two months for branch officials to distribute NSWNMA materials and talk to employees.

Deearne said this would give her and other branch officials more time

to meet staff and explain issues face to face, rather than relying solely on written material.

“Most people are really time poor these days,” she said. “Some feel they don’t have the time to read a two-page document even if it directly affects them.

“At present, I can talk to my colleagues that I work alongside but it’s hard for me to get to other areas of the hospital to talk to people.

“Like other branch officials I go in to work on my days off to put up flyers and hand pamphlets around, or I do it before and after my shift.

“Paid time for branch officials will allow us to go around the floor and inform and educate people, which will be invaluable in the future.”

MACARTHUR BRANCH VOTED YES

At Macarthur branch, which covers Campbelltown and Camden hospitals in South Western Sydney Local Health District, almost 70 per cent of members voted to accept the interim offer.

Branch president Nichole Flegg said members saw the increase in night shift penalty rates as an important part of the government’s offer, “once the history of previous claims and the advice from the NSWNMA legal team was explained to members”.

“Most members do some degree of night shift and they were happy with

the shift loading going up for the first time since 1972,” she said.

“We would have liked the 30 per cent we asked for but we weren’t guaranteed to get any penalty increase at all out of the IRC, considering the history of our previous claims.”

Nichole said increased union rights such as paid time for branch officials to do union work was a welcome feature of the offer.

“I explained to members that this will allow us branch officials to spend more time explaining issues and getting feedback from them.

“It will be protected time that's actually going to allow us to get around and see everybody and deal with issues, instead of having to do it in our own time on breaks or days off.

“I think the protected time being allocated will lead to a better informed and more active branch.”

— Nichole Flegg

“People understood the value of that improvement, especially when I explained that branch officials normally have to do all union work in our own time.

“I think the protected time being allocated will lead to a better informed and more active branch.”

Nichole said members welcomed the improvements to rostering in the interim offer.

“The ‘no night shift before annual leave’ provision was a big selling point.

“It has been a common practice for some to be put on night shift the day before they are due to start their annual leave, which means they are actually working into their annual leave.” n

Nursing wages must increase – minister

Health Minister Ryan Park has said the state government understands it needs to increase the wages of nurses and midwives. He added that the Industrial Relations Commission’s examination of the gender pay gap is critical to this.

"I want to say this about the interim pay offer and I want to be very explicit about this: it’s an interim pay offer. The government in no way, shape or form is doing some victory lap or patting itself on the back,” Mr Park told the NSWNMA annual conference in October.

“We are not doing that – we understand it is an interim offer. We understand very, very clearly, we need to increase your wages.

“We understand the work that the independent Industrial Relations Commission is doing – particularly from my perspective around the gender pay gap - is absolutely critical.

“So, by no means are you going to see me, [Mental Health] Minister [Rose] Jackson, the premier, or the treasurer do some form of public victory lap about where we are up to at the moment."n

A new frontline role for nurses and midwives

Hope for a healthier planet and a sustainable future is built on action and solidarity, says Catelyn Richards.

“It's not always expertise that leads to influencing change. It’s courage, compassion and unrelenting tenacity.”

—Catelyn Richards

When registered nurse

Catelyn Richards began her career in paediatrics, she thought her greatest challenges would be learning how to comfort anxious children and their families.

She recalls a simple technique she used on nightshifts: gently replacing her fingers with an oximeter probe in a toddler’s hand so they could sleep while she took her observations. Over

her years on the ward, she estimates she held hundreds of small hands. When she began her nursing career, Catelyn’s focus was on developing those all-important clinical skills and one-on-one patient care. In more recent years, her attention has turned to a larger-scale health issue that she believes nurses and midwives are uniquely positioned to lead: the response to the environmental crisis the world is facing.

A WAKE-UP CALL IN A HEATWAVE

For Catelyn, the turning point came during the Black Summer of 2019–20, when she left home at 5:45am for an early shift at Melbourne’s Royal Children's Hospital. The air was “thick, hot and sticky… like walking through cream,” says Catelyn, who is now the Australian Nursing and Midwifery Federation (ANMF) Climate Change Officer.

Arriving at work, she discovered that the servers hosting the digital medical record system had overheated, plunging the hospital into a digital blackout.

“Everything was on this system – patient and admission history, vital signs, trajectories, med charts, progress notes – all gone,” said Catelyn, speaking at the NSWNMA’s professional day.

While she has had moments in her nursing career “where I have been extremely worried, this was the time that I felt most out of my depth”.

While the outage was eventually fixed, the experience taught Catelyn just how vulnerable health systems are to environmental disruption.

“We were lucky because we were in a well-resourced hospital. That’s not the case everywhere in Australia, and certainly not worldwide.”

The COVID-19 pandemic that arrived soon after this experience cemented for Catelyn the stark reality that nurses and midwives are working in an increasingly uncertain and challenging world.

For Catelyn, climate change is not only an environmental issue – it’s a health emergency.

“Climate change directly impacts health through increases in things like vector-borne diseases like dengue and malaria. Almost the entire population now breathes unhealthy air as a result of burning fossil fuels, which is linked to many diseases, including asthma, lung cancer and strokes.”

Heatwaves trigger heart attacks, exacerbate kidney disease and are linked to cardiorespiratory disease and decreased mental wellbeing, says Catelyn, who is completing a PhD in planetary health and nursing.

Nurses and midwives are the first responders when smoke causes a child’s asthma to worsen, or when an elderly patient collapses in a heatwave, she says.

“In the face of significant contextual difficulties, it’s nurses, carers and midwives who continue to provide life-supporting care, who show up for the communities they serve.”

PRACTICAL ACTION

Catelyn admits that, for a long time, she felt that activism was not something she could be involved in: “I’m a nurse. I work with people, not the environment.”

Seeing her young patients – some who had to “come into the hospital to be pumped with airway openers and hooked up to IV lines weekend after weekend due to an acute exacerbation of asthma” – changed her mind.

In 2021, she co-founded Climate Action Nurses, a national network dedicated to empowering nurses to speak up and take practical action. Today, in her role with the ANMF, Catelyn is helping to place climate change firmly on the union’s agenda. It is now one of the federation’s six strategic priorities, reflecting the profession’s recognition that planetary health is inseparable from human health.

Her work involves building relationships with national groups such as the Climate and Health Alliance, Better Futures Australia, and Renew Australia for All.

“I provide support to ANMF branches, helping to assess what members really want and is needed

by way of resourcing for climate change and preparing for climate change,” she says.

She has been involved in launching an ANMF multi-branch initiative to coordinate climate action across states and territories. And she advocates for nurses, midwives and carers in state and national policy forums, ensuring nurses and midwives’ voices shape national climate risk assessments and resilience planning.

What excites her most is hearing about the grassroots projects already happening across Australia, including nurses and midwives leading waste reduction initiatives and advocating for energyefficient facilities.

“Nurses, midwives and carers are all wanting to take action and are already leading incredible work. It just needs to be scaled.”

TIME TO END OUR SILENCE

Hope for a more sustainable future is built on action and solidarity, Catelyn says.

She points to the International Council of Nurses’ recently updated definition of nursing, which now explicitly includes environmental sustainability. The International Confederation of Midwives has also declared climate change a threat to maternal and child health.

On the ground, building hope might involve taking part in local audits of workplace practices, participating in union reference groups, or attending environmental health seminars.

You don’t need to be an expert to begin taking action, Catelyn says. We don’t need “a deep scientific understanding before we're allowed to act… It's not always expertise that leads to influencing change. It’s courage, compassion and unrelenting tenacity.”

“We are the largest group of health professionals, comprising over half the total workforce, and our union together is the largest in Australia: 345,000 members strong.”

“Imagine the impact we could have if we all ended our silence and said, ‘This isn’t right’?”n

The International Confederation of Midwives has declared climate change a threat to maternal and child health.

NSWNMA fights for Healthscope jobs and entitlements

The NSWNMA is fighting to protect the jobs and entitlements of members employed by Healthscope hospitals.

“We continue to lobby (federal and state governments) to intervene and support jobs and the delivery of patient care to the community.”—Shaye Candish

The future of Healthscope remains in doubt after it went into receivership in May with $1.6 billion in debt.

Healthscope is Australia’s second largest privately owned hospital operator.

It was previously owned by the giant Canadian-US private equity company Brookfield, which loaded up Healthscope with debt as it repatriated profits back to investors.

Brookfield then placed its distressed business on the market, before handing Healthscope over to their lenders and exiting the company entirely.

As part of creating a competitive sale process, one of the options currently being proposed by the current management is to restructure Healthscope into a not-for-profit company which, they say, would save money on payroll and land tax and help retain its network of 37 hospitals.

In an email to staff in September, chief executive Tino La Spina said Healthscope had received offers for some of its hospitals but could not find a buyer for the company as a whole.

He said turning Healthscope into a not-for-profit company could avoid Healthscope being broken up with some hospitals “stranded without a buyer” and closed.

He said the not-for-profit proposal “gives us the best chance to keep our hospitals together and minimise the risk of closures and job losses.”

La Spina also made a pitch to staff to

adopt a salary packaging proposal, which he said was necessary to enable Healthscope to make tax savings and secure not-forprofit status.

The current salary packaging proposal would see 90 per cent of the benefits of a salary package program go to the company and 10 per cent to employees.

DOUBTS ON SALARY PACKAGING PROPOSAL

As The Lamp goes to print, Healthscope is proposing to ask all staff nationally to vote on an amendment to their enterprise agreement to introduce salary packaging.

NSWNMA General Secretary Shaye Candish said Healthscope had asked all ANMF branches to support the not-for-profit proposal.

She said that in NSW, given Healthscope has indicated plans to incorporate the salary packaging proposal into a vote on the longdelayed EBA as a whole, any response must be considered very carefully.

“At this point, Healthscope executives have not provided enough detail on what the salary packaging structure would look like,” she added.

In an email to members, Shaye said, “Throughout this administration process, your union has been fighting to secure your jobs and entitlements, regardless of who the ultimate new owner/s of Healthscope facilities are.”

“We continue to lobby (federal and state governments) to intervene and support jobs and the delivery of patient care to the community.”

Shaye said it was not certain the not-for-profit proposal would receive regulatory approval from the Australian Charities and Notfor-profits Commission and the Australian Taxation Office.

“Healthscope will also need to satisfy lenders that its (not-forprofit) proposal is financially viable, and likely to result in the repayment of debts and/or a return on investments,” she added.

She said it was unclear what would happen if Healthscope failed to get the necessary regulatory approvals and support from lenders.

“In the worst-case scenario of a hospital or hospitals closing, your union is working to secure your pay and entitlements, and government support for employees impacted by any closures.”n

‘Respectful and constructive’ talks on pay agreement

NSWNMA officials and Healthscope have discussed the possibility of reaching an agreement as an alternative to continuing Fair Work Commission proceedings on back pay and pay increases for Healthscope nurses and midwives.

Shaye said Healthscope agreed to consider a series of union proposals at a “very respectful and constructive” meeting on 24 September.

“These proposals included an earlier date for the payment of back pay, and maintenance of existing annual leave provisions.”

She said meetings of members and organiser visits to hospitals had shown that members’ priorities were to secure back pay and entitlements as soon as possible. n

Reliving trauma near death

Safe end-of-life care for trauma survivors requires a light touch and a long reach, says Palliative Care Nurse Practitioner Nikki Johnston.

In the days before Nikki Johnston’s great-grandmother, Grace, died at the age of 92, she would fight off invisible attackers with her walking stick.

“Grace had five children and was married to a violent man in the 1930s. She made a courageous decision to leave him, raising her children in group houses,” says Nikki, who at the time of Grace’s death was just beginning her career as a registered nurse.

Now a palliative care nurse practitioner who has spent years observing people in their final days, Nikki has a clearer understanding of what Grace was experiencing: she was reliving trauma near death.

Nikki’s PhD research into safe endof-life care for trauma survivors was prompted by her desire to understand why some aged care

residents die peacefully, while others experience heightened distress, physical symptoms, and resistance to care.

“I started noticing a pattern,” Nikki told an audience of NSWNMA members at our recent Professional Day. “Residents who died with greater distress often had a history of trauma, frequently hidden and almost never documented.”

An elder from the stolen generations panicked during showers, reliving childhood abuse. A mother whose 18-month-old son had died in a domestic accident a decade earlier experienced inexplicable pain before her death.

For trauma survivors, the endof-life can mean a return to feelings of helplessness and fear. In cases involving dementia, the situation is compounded.

“Residents who died with greater distress often had a history of trauma, frequently hidden and almost never documented.”

“Dementia can exacerbate trauma symptoms,” Nikki says. “And trauma increases the risk of developing dementia.”

Older women, for whom dementia is the leading cause of death, are particularly at risk of reliving trauma near death.

“Women and girls experience trauma twice as often as males – they have a higher incidence of being victims of violence and sexual abuse.”

When someone near death shows agitation, refuses care, is aggressive or, alternatively, withdrawn, those behaviours are typically associated with dementia or psychological decline, said Nikki.

Instead, she suggests that we challenge this framing. “Instead of behaviours, let’s change the narrative and call these ‘communications’: Communication of pain, fear, shame, loss of control, mistrust and powerlessness.”

CHANGING SYSTEMS, NOT PATIENTS

Nikki has been calling for systemic change in the way we support trauma survivors nearing death for more than a decade. While working in residential aged care in 2014, Nikki pioneered Palliative Care Needs Rounds, an evidence-based model, launched on a shoestring budget.

“Aged care staff were stressed, and residents were dying badly, with

NIKKI JOHNSTON

“Instead of reactive service, I wanted to create a proactive alternative.”

Transforming Gabby and Nancy’s end-oflife care

increased intervention and suffering. Families were distressed. Instead of reactive service, I wanted to create a proactive alternative, a model that had a light touch and a long reach.”

Palliative Care Needs Rounds consistently led to earlier identification of residents who were at risk of dying and improved quality of death. Residential aged care staff reported significant increases in confidence, knowledge and capacity in managing palliative care needs. Hospitalisations were reduced, allowing more residents to die in their preferred place of death.

Nikki says the pilot program influenced the Commonwealth Government’s decision to begin to invest in palliative care within residential aged care, commencing with a six-year funding program of $57.2 million commitment in the 2018 to 2019 federal budget. This national program has now been adopted in all states and territories.

Yet, for trauma survivors, especially those with dementia, access to palliative care remains limited.

“Only 2.4 per cent of people with a dementia diagnosis access specialist palliative care, compared to 75 per cent of those with a terminal cancer diagnosis,” Nikki noted. “This is a stark inequity.”

“Let’s influence better end-of-life care for trauma survivors, ” Nikki urged. “Let’s be curious. Let’s lean in, be present. Trauma survivors deserve to die with dignity, just as others do.”n

Gabby was 42 and had advanced cervical cancer. She avoided hospitals, resisted treatment, and experienced night terrors followed by pain crises. Health care workers labelled her difficult, but her care changed when a palliative nurse gently asked: “Gabby, have there been times in your life when you felt unsafe or in a situation that you had no control over, and you felt distressed?”

Gabby’s partner Sue revealed Gabby’s history of sexual and physical violence, resulting in the traumatic loss of her unborn child. Understanding that she was reliving this trauma near death reframed her symptoms, leading to more compassionate, trauma-informed care. Gabby chose to die in a palliative care unit, not a hospital, and passed peacefully.

In another case, Nancy, a 76-year-old woman with advanced dementia, became increasingly distressed, particularly during personal care. Her cries of “Stop, don’t hurt me” were initially seen as cognitive decline – until a nurse recognised them as trauma cues.

A family meeting revealed Nancy’s history of childhood sexual abuse. Her care was altered dramatically: only female staff were assigned, a night light was kept on, and her family remained by her side. With appropriate symptom management and safety in place, Nancy died peacefully eight days later.n

Ask Shaye

Unfair dismissal of a casual

I am an RN, and I have been working casually in a major tertiary referral hospital. I have worked weekly shifts for the last six years. Recently I was told because I am a casual staff member management can just end my employment at any time. Is this true?

Some casual employees, like permanent staff members, are protected against unfair dismissals in NSW. A casual employee may be able to make an unfair dismissal claim if they have met the minimum employment period and have worked regularly and systemically. If your employer wants to terminate your employment they need to have a genuine reason, advise you of this reason and give you the opportunity to respond. If they don’t have a valid reason or have not provided you procedural fairness before terminating your employment your dismissal may be found to be ‘unfair.’

As you have worked weekly shifts for the past six years, if your employer does not provide a reason to end your employment you may have a right to bring an unfair dismissal claim seeking reinstatement. There is a strict 21-day timeframe from the date of termination to bring an unfair dismissal claim so it’s important you contact NSWNMA immediately if this happens to you.

Criteria for higher grade duties

Last month my NUM was away for a few weeks. I was informed by the NUM before she went on leave that I would be the Acting NUM during her absence and I was even marked on the roster as the Acting NUM. I was then informed by my NUM’s line manager that due to the number of patients during this period I would not be able to receive higher grade duties. Is this correct?

No. Clause 24 of the Public Health System Nurses’ and Midwives’ (State) Award outlines the criteria which must be met for an individual to

When it comes to your rights and entitlements at work, NSWNMA General Secretary Shaye Candish has the answers.

receive payment for higher grade duties. In short, it provides that an employee who is called upon to relieve, and does relieve, an employee in a higher classification for a continuous period of at least five working days, shall be entitled to receive the minimum payment for that higher classification. There is no reference in that criteria to patient numbers or patient acuity and therefore you are eligible for the higher-grade duties’ payment. You should raise this with management and direct their attention to clause 24. If your higher-grade duties are not properly paid, contact the Association for assistance.

Choices over 12-hour shifts

I work in a public hospital and my manager has recently mentioned that our unit will be moving to 12-hour shifts. This will not suit me for a range of reasons. Do I have any choice about this?

Yes, you do have a choice. Clause 5(v)(a) of the Public Health System Nurses’ and Midwives’ (State) Award provides that participation in a 12hour shift system is voluntary and alternative shift provisions must remain available for staff who do not agree to participate.

If your manager indicates that you do not have a choice or if you are being pressured in any way, you should direct their attention to this clause and contact the Association if further assistance is needed.

Your employer should also advise the Association in writing of any intention to introduce 12-hour shifts by no later than 4 weeks prior to the proposed date of commencement. This is to allow for consultation to occur with all potentially affected employees. If you have reason to believe that the Association has not been notified you should contact us immediately.

Things to consider when undertaking a diploma

I am considering undertaking an Advanced Diploma of Enrolled Nursing qualification interstate. What should I be aware of?

Qualifications from interstate providers are generally recognised nationally, however you should confirm with the Nursing and Midwifery Board NSW and your employer that the specific course will be eligible for the continuing education allowance (CEA) at your workplace and at which pay increment you will be placed on upon completion as per the relevant Award or Enterprise Agreement.

Not all types of advanced diplomas will be sufficiently relevant to receive a CEA in all workplaces.

You should also consider the cost and duration of the course and whether the interstate provider offers online coursework which could be completed from NSW.

If the course is provided by a private Registered Training Organisation (RTO), you may also wish to research any customer reviews of the provider before proceeding to ensure that you are satisfied with the quality and content of the course and provider.

Casual shift lengths

I have started work as a casual RN for a home care provider of aged care services. I am employed under the Nurses Award 2020. I have been rostered to work a one-hour shift, is this appropriate?

Clause 11.3 of the Nurses Award 2020 requires that casual nurses are paid for a minimum of two hours for each engagement. This means that even if you are rostered to work for one hour, your employer is required to pay you for two hours. If you believe you’ve not been paid correctly, you can raise this with your employer and contact NSWNMA for further assistance if you’re not able to resolve the issue.

Branch Beat

Branch Beat with NSWNMA Assistant General Secretary Michael Whaites

Employees of Mercy Health will get substantial back pay after a NSWNMA branch official and councillor discovered the company was not paying meal allowances for overtime.

The back pay will be worth thousands of dollars to some workers. It will apply to staff at Mercy’s NSW aged care centres in Albury, Harris Park and Young.

Mercy is examining pay records of about 800 current and former employees and has made an initial payment of about $40,000 to 18 NSWNMA members.

Care worker Lannelle Bailey, a NSWNMA branch official at Mercy Place nursing home in Albury, made the discovery that staff were not being paid meal allowances for overtime.

This was a breach of the Mercy Health enterprise agreement, which says meal allowances must be paid after the first and fourth hours of overtime and every subsequent four hours.

Mercy Health has acknowledged the error and promised to compensate all staff for any payments missed during the previous six years – the standard limitation period for civil claims.

The aged care sector has traditionally been low paid, with a high proportion of part-time and casual workers. Many are recent migrants to Australia including temporary visa holders worried about job security. These and other factors have made aged care a difficult sector for unions to operate in.

However, there has been an upsurge of interest and involvement by Mercy staff in union matters since it uncovered and acted on the payroll error.

More Mercy Health workers have joined the NSWNMA, and they are more inclined to approach branch officials for advice and help.

The Albury branch is building on this success by striving to make the workplace a ‘safe space’ where staff have the confidence to approach branch reps and get involved in union activity.

Creating a ‘safe space’ for staff to ask questions

Lannelle Bailey is a member of the NSWNMA’s statewide council and a workplace steward for the Mercy Health Albury branch.

She describes herself as “a bit of a nerd” who took the time to study the enterprise agreement. She realised the meal allowance error while doing admin work in between her carer duties.

Lannelle sought advice from NSWNMA organisers who confirmed that Mercy appeared to be in breach of the enterprise agreement.

“We decided to organise an initial claim for back pay as a test case,” she said.

“We told members that if they wanted to be part of an initial claim, they would need to provide their pay slips and time sheets for the union to review.

“We got 18 members largely through word of mouth and the union sent their information to Mercy Health in September 2024.

“Management acknowledged the error and advised all staff that

‘Members and even non-members were reaching out to our branch executive to ask what this meant for them and did they need to do anything to make a claim.’

they were reviewing everybody's circumstances. They said they would compensate everyone for any payments they had missed.

“The initial group of 18 got their back pay in January.”

WORD OF MOUTH IS BEST

Lannelle said the issue generated a lot of discussion among members at work.

“Members and even non-members were reaching out to our branch executive to ask what this meant for them and did they need to do anything to make a claim.

“It has been one of the key topics for every branch meeting since the issue started in September last year.

“It has got more people interested in the union and they are interacting with branch officials a lot more.

“Members are starting to look at the enterprise agreement and understand their rights better and question things.”

The Albury branch communicates directly with members via a WhatsApp group and email. It can also send text messages via the Association’s communications unit.

However, Lannelle has found word of mouth to be the most effective means of communication.

“I think it’s vital that branch officials strive to make their workplace a safe space where staff feel comfortable to come and ask questions,” she says.

“They need to know they can get accurate information without feeling like they're being spoken down to.

“Also, some people may not have enough English to read and understand all written communications or documents like the enterprise agreement.”

FIND A NERD IN YOUR BRANCH

Does Lannelle have any advice for other aged care branches if members suspect they are being underpaid or missing out on their legal entitlements?

“My suggestion would be to find a member in your branch who is a bit of a nerd like me and doesn’t mind reading through the EBA and looking at payslips.

“If they detect any anomalies then the branch can start to have conversations with other members

‘Members are starting to look at the enterprise agreement and understand their rights better and question things.’

“Thanks to the work value case and the increase in wages for aged care staff, a lot of people feel they are in a better position to consider taking that leap and joining the union.”

Meanwhile, the Association is concerned that Mercy Health is taking too long to make good on the promise it made in December to provide back pay.

to see if there are any patterns of underpayment or non-payment.”

Lannelle says that recent wage increases in aged care won after years of union action have helped to recruit members to the Association.

“Until recently, people felt they just couldn't afford to take union fees out of their pay when wages were so low, and everything was so tight.

At the time of writing, Mercy had not updated staff since its email acknowledging the error in December. n

LANNELLE BAILEY, NSWNMA STATEWIDE COUNCIL MEMBER AND BRANCH OFFICIAL

NSWNMA acts on racism survey

The Association will work with the Australian Human Rights Commission and employers to combat racism in the health and aged care sectors.

Seventy per cent of nurses, midwives, AINs, and care workers believe racism exists in their workplace, a NSWNMA survey shows.

Of those survey respondents who identified as having a culturally and linguistically diverse (CALD) and/or Aboriginal and Torres Strait Islander background, 64 per cent said they had been a victim of racism.

The Standing Together Against Racism report recommends changes to polices, systems and training including bystander action education for all staff.

NSWNMA Assistant General Secretary Michael Whaites said key stakeholders including employers, regulators, and government have agreed to collaborate on improvements to racism education and reporting with the aim of creating safer workplaces.

“We hope that by working in collaboration with the AHRC, employers and government we can bring about meaningful change for both Aboriginal and Torres Strait Islanders and those from other racially marginalised communities by finding permanent and scalable solutions to mitigate racism in health and aged care workplaces,” he said.

Michael said racism represented “a genuine psychosocial risk for workers” that workers, employers and governments had a shared duty to address.

A total of 3289 members from public health, private hospitals and aged care took part in the survey.

It shows the main forms of racism were racial bias, stereotyping and gaslighting.

One in five respondents said they had been verbally abused or insulted, one third reported bullying, and 27 per cent complained of a lack of career opportunities.

More than a quarter of Aboriginal and/or Torres Strait Islander respondents reported feeling socially alienated at work.

Some said they had to hide their cultural background, while others said the Voice to Parliament campaign had made workplace racism worse.

Colleagues were cited as the main source of racist behaviour by 68 per cent of respondents. Managers were identified in 43 per cent of responses, with residents/patients pinpointed in 41 per cent of replies.

The survey found 88 per cent of nurses, midwives and carers who reported an incident of racism received no support, while 73 per cent did not report it to management at all due to a lack of confidence in the system.

Almost 60 per cent of survey respondents had witnessed racism in their workplace in the previous week. However, only 16 per cent of those subject to racism reported that someone had stepped in to support them at the time.

Only 14 per cent of respondents said bystander education was made available at their workplace.

“It is alarming how many members said they didn’t receive support after reporting an incident, that their cases were poorly managed, ignored or trivialised,” Michael said.

“For some respondents that meant leaving their job, or their profession entirely, because of the lack of action to address racial abuse and discrimination.”

He added however that the report demonstrates the potential for wellsupported bystander action including the widespread implementation of bystander education initiatives.

The AHRC's Race Discrimination Commissioner and the Association are bringing the stakeholders together again in December to plan the next steps.n

“It is alarming how many members said they didn’t receive support after reporting an incident, that their cases were poorly managed, ignored or trivialised.”

—Assistant General Secretary

Michael Whaites

MINISTER PARK , MICHAEL WHAITES, DR ALI DRUMMOND, SHAYE CANDISH, GIRIDHARAN SIVARAMAN AT THE LAUNCH OF THE STANDING TOGETHER AGAINST RACISM REPORT

Growing migration brings a more diverse workforce

The Standing Together Against Racism report points out that Australia relies on nurses and midwives with overseas qualifications to plug workforce gaps.

In 2023–24, 16,622 international nurses and 351 international midwives entered the profession in Australia.

This represented a 48.6 per cent and 28.6 per cent increase respectively compared to the previous year.

There is a steady stream of new migrant workers due to the Pacific Australia Labour Mobility (PALM) scheme and the new Aged Care Industry Labour Agreement – initiatives that recognise overseas qualifications and offer increases in the number of eligible countries whose nurses can access streamlined registration pathways.

The report says Temporary Skilled Visas granted to UK and Irish health and aged care staff “have decreased to almost insignificant numbers, while visa holders from India, the Philippines and Nepal have commenced a resurgence in the last two years”.

“These figures show our health and aged care workforces are growing in diversity and this should inform employee support strategies going forward,” the report says.n

Glass ceiling to career advancement

Media coverage of the Standing Together Against Racism report featured Zimbabweborn nurse Loveness Tsitsi Mauwa, who spoke about a “glass ceiling” faced by nonwhite nurses.

Loveness told SBS News that when she started her first nursing job in a NSW hospital, a colleague told her there was a “template” for career success.

"She told me to progress, you have to be young, Caucasian and beautiful. And at that time, it didn't make sense to me,” Loveness said.

But as she stayed in the sector for longer, she realised the template existed.

In the following decade, Loveness applied for various opportunities to progress her

career, only to find she often didn't make it to the final stage.

"I did put out some applications, and in one of the applications, I was promised I was going to get an opportunity, but that opportunity never came, but everyone else who had applied who met the criteria was able to progress,” she said.

Loveness said that in the 25 years she has lived in Australia, she has seen the workforce become more culturally diverse – but barriers still exist.

"I think the health system is happy if we [are] just working on the floor but not wanting to progress into management or senior roles, so that is where it becomes a challenge."n

“I think the health system is happy if we [are] just working on the floor but not wanting to progress into management or senior roles.”

— Loveness Tsitsi Mauwa

Professional Perspectives

Practice related to vaccinations

I work in a busy GP clinic where I give a lot of vaccinations. We have a small waiting room and sometimes there aren’t enough seats for patients to wait 15 minutes after receiving their injection/s, so they leave. What can I do?

Practice related to vaccinations is set out in the Australian Immunisation Handbook. It requires that immediately after you administer a vaccine you must keep the patient under observation for at least 15 minutes. This is to ensure they don’t experience an immediate adverse event – so they can receive rapid medical care if they need it. They also shouldn’t drive in that 15-minute period.

It’s good practice to explain to every patient before you administer their vaccine that this is a requirement and that it’s for their own safety. Ask them to verbally confirm that they agree to the wait time in the clinic. After you’ve given the vaccine, remind them what time they can leave. To manage the 15-minute timing, some practices set reminder alarms for each patient, some give patients laminated reusable cards with their exit time. Others have dedicated chairs within sight of staff, so

consider putting a ‘reserved’ sign above a seat to keep it free. It’s helpful to explain the 15-minute observation requirement to reception staff so they understand it’s a matter of safety, particularly if you have back-to-back appointments and a packed waiting room. If a person leaves before at least 15 minutes passes, make sure you document in your notes that you explained the waiting requirement and if they verbally agreed to it, and how you indicated what time they could leave – then include what time they did leave. It’s important to document your own good practice in this situation. You can find more information about vaccination after-care and documentation here: https:// immunisationhandbook.health. gov.au/contents/vaccinationprocedures/after-vaccination

Providing holistic, culturally appropriate healthcare to Aboriginal and Torres Strait Islander people

In our metro hospital we have a patient who identifies as Aboriginal who’s nearly ready for discharge. I want to help him connect with some community services. How can I do this?

The first step is to contact your hospital’s Aboriginal Health

Liaison Service or Aboriginal Health Liaison Officer (AHLO). They may have had a yarn with the patient already. Usually when patients are admitted they’re asked if they identify as Aboriginal or Torres Strait Islander. If they say yes and would like to see the AHLO, the AHLO or Service will be notified. AHLOs have wide-ranging roles to support Aboriginal patients, and they’ll know of and have connections with relevant support services (whether related to health, housing, family support, legal help, etc).

If the patient has a chronic condition and needs ongoing support in the community, your local Integrated Team Care (ITC) service can provide support to Aboriginal people with chronic disease in a geographical area. ITCs have established referral pathways between acute and primary care.

In ITC programs, Aboriginal and Torres Strait Islander outreach workers can help clients with nonclinical tasks, and care coordinators support clinical care by arranging services in clients’ GP care plans, organising regular primary care reviews and supporting clients to build health literacy, among other services. Clients can be referred to the ITC program by their GP, or via an Aboriginal Medical Service or Aboriginal Community Controlled Health Services.

Aboriginal Community

Controlled Health Services (ACCHS) are community controlled – meaning they are incorporated Aboriginal organisations initiated by and located in a local Aboriginal Community. Aboriginal Medical Services may be community controlled or government-run. Both services provide holistic, comprehensive and culturally appropriate healthcare to Aboriginal and Torres Strait Islander people, including medical, dental, mental health, drug and alcohol, and public healthcare.

You can search for local NSWbased Aboriginal and Torres Strait Islander health professionals here: https:// healthinfonet.ecu.edu.au/keyresources/health-professionals/ health-workers/ map-of-aboriginal-and-islanderhealthmedical-services/.

Providing respectful care

How should a midwife respond if a woman declines a recommended procedure?

Respect her decision, provide clear information about risks and alternatives, document the discussion, and continue to offer safe, supportive, and culturally respectful care. This aligns with NMBA Professional Standards for Midwives (2018) and the Code of Conduct, which emphasise woman-centered practice and professional respect.

• Provide clear, evidence-based information. Explain the risks, benefits, and alternatives in an understandable and culturally sensitive way. Ensure the woman has the opportunity to ask questions

• Respect autonomy and cultural values. Acknowledge her decision without judgment and recognise her legal and ethical right to decline interventions

• Maintain safety and partnership. Continue to monitor and provide safe care within scope, escalating concerns if the situation changes or becomes an emergency.

• Document thoroughly. Record the discussion, information provided, the woman’s decision, and any agreed plan for ongoing care.

This approach ensures care remains woman-centered, ethical, and legally accountable, while maintaining trust and collaboration between midwife and woman.

The Association’s professional team answers your questions about professional issues, your rights and responsibilities.

Ramifications of accepting a Friend Request from a patient

I work at a hospital and was caring for a patient. After they were discharged, I noticed they added me on Facebook. Can I accept their Friend Request?

No. Nurses and midwives must maintain professional boundaries with patients, even after the therapeutic relationship has ended. Accepting a patient’s Friend Request on social media can blur those boundaries and create risk around confidentiality, privacy and professionalism.

The Nursing and Midwifery Board of Australia’s (NMBA) codes of conduct and social media guidelines are clear: professional relationships should not extend into personal online spaces.

Accepting a Friend Request from a patient can have serious professional ramifications for your registration, including complaints or disciplinary actions. If you receive a request from a current or former patient, the safest course is to decline it.

Renewing registration

I forgot to renew my nursing registration on time. What happens now?

If you miss the registration renewal deadline, you are not legally permitted to practise as a nurse or midwife until your registration is current again. Even if you continue to work, you are putting yourself and your employer at significant risk.

The Nursing and Midwifery Board

of Australia (NMBA) allows a short late period (with a late fee) during which you can still renew, generally until the end of June. If you miss this window, your registration will lapse, and you will need to apply for re-registration before returning to work. We recommend checking your registration renewal status via the Ahpra portal.

New prescribing standards

The NMBA has announced a new prescribing standard for RNs. When will this start, and what does it actually mean for me as an RN?

From 30 September 2025, RNs who meet the Registration standard: Endorsement for scheduled medicines - designated registered nurse prescriber requirements will be able to apply for endorsement to obtain, possess, supply, and prescribe Schedule 2, 3, 4, and 8 medicines. Prescribing must be done in partnership with an authorised health practitioner, under a clinical governance framework, and with a prescribing agreement. This must be done in accordance with the relevant standards, guidelines, and applicable state and territory legislation.

You can read more about the new registration standard on the NMBA website. https://www. nursingmidwiferyboard.gov.au/ Registration-Standards/ Endorsement-for-scheduledmedicines

AUSTRALIA

Qantas: “The wrong kind of sorry”

Federal Court judge accuses airline of “performative remorse” and fines it $90 million for illegally sacking 1,820 baggage handlers.

Justice Michael Lee handed down his decision nine months after Qantas and the Transport Workers’ Union agreed the airline would pay $120 million in compensation to the sacked workers, taking the total cost of its illegal outsourcing decision to more than $200 million. $50 million of the penalty would go to the Transport Workers’ Union, the judge said.

Lee said allocating a significant proportion of the fine to the TWU would incentivise unions to pursue potential breaches of the Fair Work Act when the federal ombudsman fails to act, as he said it had in the case of Qantas.

Lee said he felt a “sense of disquiet and uncertainty as to precisely what went on within the upper echelons of Qantas leading up to the outsourcing decision” and described the airline as having “the wrong kind of sorry”.

Among the reasons Lee gave for imposing the record penalty was the airline’s attempts to obscure the decision-making process behind the outsourcing and the role the then chief executive officer, Alan Joyce, had played.

The TWU national secretary, Michael Kaine, said the union had won a “David and Goliath” battle and secured “the most significant industrial outcome in Australia’s history”.

The New South Wales Labor senator Tony Sheldon, a former TWU national secretary, said the $90m penalty against the airline confirmed workers had been “sacked in a ruthless, calculated act of corporate cost-cutting”.

FRANCE

French Ramsay staff win “very satisfactory” agreement after 24 days of strikes

It took nearly a month of action, determination and solidarity to force the management of a health facility in Capbreton, in south-west France – managed by the private health sector giant Ramsay Santé – to accept their employees’ claims.

In the agreement Ramsay Santé employees won:

• the payment of bonuses

• an increase in the lowest wages

• a revision of the profit-sharing agreement

• €38,000 for the next annual negotiation.

The agreement was described as "very satisfactory" by the French Confederation of Labour (CFDT).

“In a facility where €6 million has been invested in modernisation but without fairly valuing human labor, workers have reminded us that without them, nothing works,” the union said.

As part of their campaign the CFDT translated Ramsay Australia enterprise agreements into French to educate staff on what wages and conditions their Australian colleagues were entitled to.

Earlier this year the CFDT had released a report revealing how healthcare real estate speculation drains billions of euros from France's public health system, diverting crucial resources away from patient care and healthcare workers' wages.

The study, authored by the Centre for International Corporate Tax Accountability and Research, looked at the financial structure and assets of Ramsay Santé, and revealed a troubling pattern of financial extraction that threatened healthcare quality and working conditions.

“Workers had been sacked in a ruthless, calculated act of corporate cost-cutting.”

“Workers have reminded us that without them, nothing works.”

— CFDT

GAZA

The mathematics of starvation

Data compiled and published by Israel’s own government makes clear that it has been starving Gaza.

A report by The Guardian shows that the Israeli government, which controls the flow of food into Gaza, has calculated how many calories Palestinians need to stay alive and only allows a fraction of that amount into the besieged territory.

“The mathematics of famine are simple in Gaza. Palestinians cannot leave, war has ended farming and Israel has banned fishing, so practically every calorie its population eats must be brought in from outside,” the paper said.

“Israel knows how much food is needed. It has been calibrating hunger in Gaza for decades, initially calculating shipments to exert pressure while avoiding starvation.”

In 2006, an Israeli court ordered the release of documents from Cogat, the Israeli agency that controls aid shipments to Gaza that calculated that Palestinians needed an average minimum 2,279 calories per person per day, which could be provided through 1.836kg of food.

Between March and June this year, Israel allowed just 56,000 tonnes of food to enter the territory, Cogat records show, less than a quarter of Gaza’s minimum needs for that period.

The Famine Review Committee, an independent group of experts said food shipments “have been highly inadequate”.

“Our analysis of the food packages shows that [the Israeli] distribution plan would lead to mass starvation, even if it was able to function without the appalling levels of violence that have been reported,” the FRC said.

“Our analysis of the food packages shows that [the Israeli] distribution plan would lead to mass starvation.”

— Famine Review Committee

WORLD

“Healthocide” on rise in conflict zones

Medical neutrality is threatened as clinicians and hospitals are deliberately attacked, particularly in Gaza, says BMJ Global Health.

“War has devastating consequences on healthcare, with attacks becoming normalised and health weaponised,” academics from the American University of Beirut, Lebanon have written in BMJ Global Health .

The study conceptualises the systematic and deliberate attacks on healthcare as ‘healthocide’.

"We mean the intentional, systematic destruction of not only healthcare infrastructure, hospitals, healthcare workers and medical supply lines, but also the devastation of a population's health and its well-being in its entirety. In other words, healthocide refers to a shattering of the very wholeness that health itself implies," they wrote.

The authors cite data from Israel’s full-scale invasion of Gaza, which has resulted in at least 986 medical workers’ deaths. Recent figures from the Healthcare Workers Watch show that 28 doctors from Gaza are being held inside Israeli prisons without any charge, eight them senior consultants in surgery, orthopaedics, intensive care, cardiology and paediatrics.

Figures from the Safeguarding Health in Conflict Coalition recorded 3,623 attacks on or obstruction of healthcare in 2024, the highest number ever documented, The Guardian reported.

These attacks included doctors, nurses and allied healthcare professionals who were beaten, arbitrarily arrested, kidnapped, tortured and killed; patients shot in their beds or dragged to detention centres; and hospitals that were deliberately bombed and raided.

“Healthocide refers to a shattering of the very wholeness that health itself implies.”

LATIN AMERICA

International court declares care a human right

The American Court of Human Rights decision is a victory for women and care workers across the Americas, says Public Services International (PSI).

The PSI has argued for years that care is not a commodity in the market economy but a human right.

The Inter-American Court of Human Rights has concurred, and in a recent decision recognised care as an autonomous human right.

“This historic ruling confirms what we, as trade unionists, feminists and public service workers, have long fought for: care work – carried out overwhelmingly by women – is the backbone of our societies and must be decent work,” the PSI said following the ruling.

“This opinion is not only for the Americas; it sets a global standard that challenges all governments, everywhere, to follow suit: to recognise, legislate and invest in care as a human right, progressively and sustainably.”

The PSI says the decision should lead to a reorganisation of care so that:

• robust, universal, public-funded care systems with public provided services, are not the exception but the norm

• care workers – the vast majority of whom are women – have access to decent work and are recognised, protected and fairly remunerated

• gender equality is not merely an aspiration, but a lived reality. Latin American unions say the challenge now is to translate this legal decision into concrete realities: decent wages, fair working conditions, universal access to, and public provision of, care services.

“Care

work – carried out overwhelmingly by women – is the backbone of our societies and must be decent work.”

AUSTRALIA

Reducing working hours is key to improved living standards: Unions

Australians would benefit from a shorter working week, ACTU leaders told the Economic Reform Roundtable.

“Shorter working hours are good for both workers and employers. They deliver improved productivity and allow working people to live happier, healthier and more balanced lives,” said ACTU President Michele O’Neil.

The ACTU argued that workers deserve to benefit from productivity gains and technological advances, and that reducing working hours is key to lifting living standards.

Analysis by the Centre for Future Work shows the scale of the gap between productivity growth and wage growth. If real wages had grown at the same rate as productivity since 2000, average wages would be around 18 per cent higher – about $350 per week – than they are today.

The ACTU proposes that Australia move towards a four-day work week where appropriate and use sector-specific alternatives where it is not. Pay and conditions, including penalty rates, overtime and minimum staffing levels, would be protected to ensure a reduced work week doesn’t result in a loss of pay.

Sector-specific models for reducing working hours include adding more rostered days off, increasing annual leave, and redesigning rosters to provide increased predictability, security and work-life balance.

According to a peer-reviewed study recently published in Nature Human Behaviour, a four-day work week boosts performance, reduces burnout and improves employee health and retention.

“Shorter working hours are good for both workers and employers”

— ACTU President Michele O’Neil

AUSTRALIA

ACTU puts housing affordability at centre of economic debate

Australia cannot improve living standards without addressing housing affordability, say unions.

Working Australians are increasingly being locked out of owning their own homes, and rents are skyrocketing in cities and regions, in a hit to national living standards, the ACTU told the recent Economic Reform Roundtable.

The ACTU advocated for major tax reforms to tackle the national housing affordability crisis in addition to increasing housing supply.

Unions argued that negative gearing housing tax breaks and capital gains tax discounts should be restricted to a single investment property, instead of favouring those with multiple properties.

“We cannot continue down the same path of giving investors tax supports while owning your own home gets further out of reach for average workers and becomes nearly unimaginable for young people,” said ACTU Secretary Sally McManus.

Unions also support getting behind modular housing, which can be quicker and cheaper than using conventional building materials, backed by a faster development approvals process for new housing and green energy projects.

Australia’s super funds can and should do more to contribute to building more homes they say.

A concerted clamp down on tax avoidance by large companies and high-net-worth individuals should also form part of a tax reform package, the ACTU said.

“We

cannot continue down the same path of giving investors tax supports while owning your own home gets further out of reach for average workers.”

— ACTU Secretary Sally McManus

AUSTRALIA

Eating disorders linked to family hardship: study

Research challenges myth that eating disorders are ‘diseases of affluence’.

A new study from Britain that followed 7,824 children, roughly half male and half female, from birth to 18 years found those born into financial hardship were more likely than others to later experience eating disorder symptoms as teens.

Previous research had shown eating disorders can affect people from all socioeconomic backgrounds, not just those with higher economic status. But this new study is one of the first to show deprivation in childhood could be a risk factor for eating disorder symptoms in adolescence.

The study found that eating disorder symptoms were higher in young people aged 14 to 18 whose parents had suffered greater financial hardship when they were babies.

The study also found teens whose parents completed less formal education (meaning only compulsory schooling) were 80 per cent more likely to experience disordered eating patterns than those whose parents went to university.

Academics from the University of the Sunshine Coast, writing in The Conversation, said the study sheds light on the inequalities and barriers in recognising and treating disorders.

“Rates of people seeking help for an eating disorder are already low – and even lower among people from disadvantaged backgrounds,” they wrote.

“Treatment needs to be more affordable. More no-cost or low-cost services are needed to reach everyone that needs them.”

“Treatment needs to be more affordable.”

health+wellbeing

Dealing with anxiety

Everyone experiences anxiety at certain times in their life. But when our anxiety becomes chronic or relentless it can create chaos in our lives and make us feel paralysed.

Experiencing stress where we ‘peak and recover’ can be good for our body, but if we feel stressed all the time, it can cause anxiety.

We shouldn’t aim to completely rid ourselves of anxiety but instead take steps to reduce it so that we feel more capable and less in its control.

Anxiety is more common than you may think

Anxiety is the most common mental health condition in Australia. According to the Black Dog Institute, it affects a third of women and one-fifth of men at some stage in their lives.

Anxiety is more prevalent amongst nurses and midwives than the general population. Studies report rates between 20 and 38 per cent in midwives and 40 to 60 per cent in nurses.

Nurse and midwives: vulnerable to anxiety

Our work conditions place us at higher risk of becoming anxious. We are exposed to:

• high workloads

• sleep deprivation

• shift work

• time constraints

• lack of professional support

• vicarious trauma and

• staffing issues.

Lack of work/life balance, conflict with other colleagues and difficulties saying “no” when asked to do more at work also contribute to anxiety.

Anxiety can impact performance, patient care and job satisfaction and the ability to offer empathy.

Anxiety as a response to threat

Anxiety can keep us safe from danger. When we perceive a threat, it causes us to go into ‘fight, flight or freeze’. This is the limbic system, the part of the brain that is involved in emotions, memory and behaviour, working overtime to try to protect us from perceived threats. Sometimes we can become so anxious that it affects our daily life.

Anxiety affects how we think, feel and behave

It can:

• produce feelings of unease, worry, nervousness, tension, numbness, fear and paralysis

• make us focus and worry about future events

• manifest as heart palpitations, high blood pressure, irritability, sweating

• reduce your focus

• cause gut discomfort or pain

• disturb your sleep.

As a nurse or a midwife, anxiety can affect the way you function at work.

High risk groups

Nurses and midwives are more likely to experience anxiety if they:

• have fewer years of experience

• are exposed to trauma and/or death

• suffer compassion fatigue

We are all at risk of compassion fatigue, as our work exposes us to the suffering of others.

Causes of anxiety

Complex factors may combine to cause anxiety. They include lifestyle and personality types, genetic and biological factors, substance abuse, other mental health issues, life events such as trauma, abuse, or the loss of a loved one.

Coping with and calming anxiety

The good news is that you can relieve your anxiety. The brain can change itself, through a process called neuroplasticity.

Try these strategies to relieve your anxiety:

• care for yourself – rest, get quality sleep and eat well

• make regular exercise a part of your routine

• practice breathing techniques

• challenge your negative self-talk

• be kind to yourself

• ask for help when you are struggling – talk to us! Reaching out for support is important if you are experiencing anxiety. You don’t have to go it alone. Call Nurse and Midwife Support on 1800 667 877 anytime to talk.

test your Knowledge

ACROSS

1. Bacterium that causes anthrax (8.9)

9. Substance used to reduce friction (9)

10. New arrival or newcomer (7)

11. Skeletal muscle of the trunk or head (5.6)

12. Relating to a group’s cultural origin (6)

13. Symbol for carbon monoxide (1.1)

14. Related to bodily waste

16. Increased neutrophils (1.1.1)

17. Tissue that lines parts of the nervous system (15)

18. The organ of hearing

19. Without awareness or control (13)

22. Respiratory rate (1.1)

23. Auricular (4)

24. Opposite forces or movements (15)

26. The space between the parietal bones

28. Seasonal viral infection (3)

29. Hormone responsible for male characteristics (10.7) DOWN

1. Eye tissue that covers the eyeball (6.11)

2. Bone found in the midfoot (7)

3. A temporary substitution of one physician by another (5.6)

4. Elbow joint (11.6)

5. A taxonomic category between genus and subfamily

6. Ability to respond or react (11)

7. Beginnings or starts (13)

8. Operation performed to treat a medical condition (8.9)

14. Feeling abandoned or hopeless (7)

15. Strain by pushing too much (11)

20. Having a hard outer layer (7)

21. Heart-shaped (7)

23. Orthotolidine (1.1.1)

25. Trunk (5)

27. Leucocyanidin reductase (1.1.1)

28. Away, back