Editorial

We’re not going away, Premier

October 11, 2024 by Madeline Lucre Leave a Comment

A statewide strike and large, dynamic rallies have shown Chris Minns and his government our resolve as we pursue a just and deserved pay rise.

Kogarah didn’t know what hit it.

On September 10, a tsunami of nurses and midwives from all of Sydney’s main metropolitan hospitals converged on the city’s southern suburb to rally outside the Premier’s electorate office and repeat the message Chris Minns has so far ignored: we deserve a 15 per cent pay rise.

For all the good humour and energy of those present, there is still a palpable sense of frustration and impatience among nurses and midwives in the Public Health System with the government’s intransigence over our pay.

During the terrible ordeal of COVID-19 when nurses propped up a bursting hospital system and literally put their lives on the line to protect

the citizens of NSW, the Liberal- National government of the time rewarded them with a wage freeze and a callous disregard.

The NSW Labour opposition rightly took the Perrotet government to task for their dereliction of duty to the community, the health system and its workforce.

They promised better and nurses and midwives took them at their word.

Many of our members gave up their precious time and energy, despite the cumulative exhaustion built up during the arduous years of the pandemic, to help get the Minns government elected.

On election day, throughout the state, voters were met at polling booths by nurses and midwives advocating for change.

With the election of a new government there was an there would be change and together we would build a robust public health system to future proof the health of NSW citizens and that the workforce would finally be treated with the respect it deserves.

Of course, ratios are central to this, and we acknowledge the government’s commitment to implementing them. But pay is also important.

In fact, it is difficult to see how ratios can be successfully implemented in NSW unless nurses and midwives’ remuneration is competitive with other states.

We understand that the government has to juggle competing demands on the budget, but the lessons of the last five years are stark and critical.

The World Health Organization has made it clear that economic policy needs to align with health goals.

WHO has warned that health demands will continue to rise and there are increased risks of pandemics due to climate change.

When we say a 15 per cent pay rise is critical, this is no empty rhetoric, it is economic logic. Keeping the nurses we have and attracting more to fill ratios will require the government to recognise the labour market realities that are influenced by the wages paid in other states.

During the election campaign the government promised to reinvest productivity savings into wages. We found those productivity savings in a business case prepared by Deloittes. These efficiencies have been validated, we now wait to see if these will drive government policy. Disappointingly, it hasn’t yet driven a revised wages offer.

The government was also elected on a platform of gender equity and gender pay gap for the public service workforce has worsened under this government. Nurses and midwives are the biggest public sector workforce, so addressing our wages also addresses the gender bias that keeps women’s wages lower.

STOP PRESS

As the Lamp went to print the largest ever strike of nurses and midwives in NSW, with rallies outside Parliament House in Sydney, in Tweed Heads, Albury and other sites, saw 10,500 members demonstrate our power. As a result the NSW Government is now willing to negotiate! For more detail go to our website.

INVOLVING OUR PRESIDENT MORE

At our annual conference a significant resolution was passed to endorse a decision by Council to make the President’s position a paid role within the NSWNMA.

To date, the President’s role has been an honorary position, requiring upwards of 20 hours per week on a voluntary basis to ensure the strong governance of this union. This was not sustainable for the future growth of our union or for those people current and previous in the President position, who are also required to work in separate paid employment and with family responsibilities.

Current and future Presidents of the Association can now take an even more active role in supporting the goals of this union to focus their time and energy on the work of our members first and foremost.

No longer will the NSWNMA President need to balance their passion for unionism with the responsibilities of their paid employment; these will now be one and the same.

Value us and our vital work!

August 2, 2024 by Madeline Lucre Leave a Comment

After the devastation of COVID-19 and the suppression of pay through a decade-long, coercive cap on wages, it is time to rebuild our public health system, starting with some respect for the workforce.

Our fight for a 15 per cent pay rise has escalated with more than 50 rallies held throughout the state in July.

Our claim is fair and justified, and essential if we are to fix the staffing crisis in the public health system and to stop nurses and midwives leaving the industry or moving interstate for better pay and conditions.

If the state government wants to attract and retain skilled and experienced nurses and midwives, it must pay them a wage that reflects the vital work they do.

NSW public sector nurses and midwives are now the lowest paid in the country. In real terms, their wages are sitting at 2008 levels, while dealing with 2024 costs.

The NSW government must face up to, and rectify, the dysfunctional labour market that has arisen from the suppression of wages over more than

a decade by the previous government through its notorious “wages cap”.

It also needs to show it is serious about gender equity. While male-dominated jobs like firefighters and train drivers have seen significant pay increases, the female-dominated caring professions have fallen behind.

We are now losing many nurses across our borders, both north and south. In Queensland a new grad makes $12,000 more and is 18 per cent better off compared to a first year NSW nurse.

If the state government wants to attract and retain skilled and experienced nurses and midwives, it must pay them a wage that reflects the vital work they do.

OUR CLAIM IS BASED ON SOLID EMPIRICAL EVIDENCE

Two recent reports – one by the University of Sydney Business School and another by Deloitte Financial Advisory – validate our pay claim.

The first points out that nurses and midwives’ pay is lower than in 2011 and a 15 per cent increase is justified to make up for the distortions in the nursing and midwifery labour markets caused by the State government’s wages cap between 2011 and 2023.

The second establishes a business case to fund a 15 per cent pay rise and the roll out of ratios statewide.

These improvements – ratios and better pay – will attract nurses and midwives back to NSW Health and make our hospitals competitive with other states in the job market.

These reports by respected business experts identify ways in which the government can fund these improvements. So, it cannot keep using a lack of money as a reason to refuse implementing these improvements.

If they continue to say “No”, it is not because they can’t pay, it’s because they won’t pay.

VICTORIAN NURSES FOUGHT AND WON

We can take some inspiration from our colleagues in Victoria who have just won a 28.4 per cent pay increase over 4 years after a protracted period of industrial action – an outcome that will help retain and recruit the staff needed to rebuild their public health system.

Even though Victoria’s budget is in deficit, the government still eventually found a way to acknowledge the value of nurses and midwives.

However, it still took pressure and perseverance from ANMF Vic members.

MORE RIGHTS, MORE PROTECTIONS FOR UNION DELEGATES

As in all our campaigns we will need to be organised and, as always, we achieve success through the courageous actions of our members.

Branch officials, delegates and activists are the backbone of our union. Every day they unselfishly and bravely represent our members in dealings with their employer. They provide an important voice for nurses and midwives in our workplaces.

We understand this role can be very difficult. Many employers don’t want their employees to have a voice in the workplace. One study in the early

2000s found that 23 per cent of delegates experienced hostility from their employer.

As respected IR commentator David Peetz says: “This hostility can put a lot of pressure onto people who, in the end, are only volunteers”.

So, we welcome the introduction of a new framework of rights and protections into the Fair Work Act that recognises the critically important work that delegates undertake and the daunting barriers they can face in the workplace. (See more p. 19).

I hope these new rights and protections will encourage more of you to become involved in the life of our union as we seek to give nurses and midwives a greater voice and increase the power of our advocacy in the public and private health systems and aged care for our patients and residents.

And we’re off!

June 7, 2024 by Madeline Lucre Leave a Comment

The rollout of ratios has started with EDs at Liverpool and Royal North Shore Hospitals in the vanguard and recruitment for the new positions under way.

It has been a lengthy process as we have methodically worked our way through the detail but, finally, we are starting to see our long and hard-fought campaign for ratios come to fruition.

The reform has kicked off in Liverpool and Royal North Shore ED with both sites each receiving an additional 35 FTEs. Recruitment has commenced and members are already experiencing the benefits of these additional nurses in their units.

The remaining level 5 and 6 EDs will commence their ratios rollout in the next 6 months. Discussions will then turn to Level 3 and 4 EDs, ICU, Maternity, wards converting to NHPPD and MPSs. (This does not indicate the roll out order).

This is a major victory for patient safety, but also, this reform finally starts to acknowledge and value you and the incredible work you do.

There is still a long way to go, as we fight for more funding from the government to ensure ratios are implemented in every ward and every unit across the five areas as the government promised. We will continue our fight for ratios in all other clinical areas across our public health system.

In a busy month we not only kick started the roll out of ratios, but we also lodged our log of claims for the Public Health System Award for 2024.

The claim seeks important improvements and sets out a plan to return NSW Health to being an employer of choice for nurses and midwives across Australia.

This will be critical if the ratios rollout is to be successful.

The claim was put together with direct input from members, and it was endorsed by an unprecedented number of members in a vote held in April 2024.

The claim calls for a 15 per cent pay rise, more funding for nurse-to- patient ratios and improved working conditions.

The log of claims committee settled on a 15 per cent figure after examining extensive data and assessing circumstances since the wages cap was introduced in 2011. It considered the spike in inflation and the productivity gains that we’ve consistently missed out on. It drew on the knowledge and experience of respected Industrial Relations experts.

15 per cent is a reasonable goal but we will still need to campaign hard to achieve it. On the one hand it is ambitious, as combined with the implementation of ratios it calls on

the government to make a substantial investment in our public health system. But it is also reasonable and responsible when considering our analysis of what is needed to attract nurses and midwives back into the system after a decade of wage suppression and the barely believable burdens placed on the nursing and midwifery workforces during COVID.

As always, we will need the support of the community and we will need to articulate our case well to galvanise their support.

A STEP FORWARD ON PAID PLACEMENTS

In this edition of the Lamp, we also look at the difficult financial situation faced by many undergraduate nursing and midwifery students during their hundreds of hours of mandatory unpaid clinical placements.

During these placements, students are expected to fund their own travel and accommodation on top of the loss of wages from their regular job.

Unsurprisingly, this leads to a high dropout rate, hardly a sensible or desirable outcome when we need all hands on deck to meet the challenges in implementing ratios.

The federal government has announced it will establish a “Commonwealth Prac Payment” of $319.50 per week to support nursing, midwifery and other tertiary students during mandatory workplace placements.

This is clearly insufficient to properly alleviate this existing “placement poverty” but it is a welcome first step and at least a recognition of the existence of the problem.

Finally, I would like to commend to you an article on Voluntary Assisted Dying. Staff from the Nepean/Blue Mountains LHD tell us how much appreciated nurses are by patients and families as they navigate this difficult process.

Nurses can be proud of their role in making this final part of a person’s life full of kindness, compassion and respect.

We can also take pride in our union and our campaigning efforts that helped to bring VAD into existence. It is heartening to know that a discussion about such a sensitive issue with many differing views can be conducted with intelligence and tolerance and with the wellbeing and wishes of patients the goal of public policy.

Working for better pay on multiple fronts

April 11, 2024 by Madeline Lucre Leave a Comment

Pay has been lagging behind the soaring cost of living. It’s time to fix this. Love for the job can’t pay the bills and we need to speak up and talk about what we are worth. It is very good news that the Fair Work Commission has topped up the wages of Assistants in Nursing and care workers in aged care by an extra 8 per cent on top of the 15 per cent it awarded last year – a 23 per cent increase overall.

The Commission’s ruling will set a new minimum award rate of $1223.90 per week for Certificate 3-qualified AINs. “The work of aged care sector employees has historically been undervalued because of assumptions based on gender,” the Commission said.

These increases are highly deserved with the increased responsibilities and additional training needed in aged care since the COVID-19 epidemic – a fact the Commission highlighted. These increases are formidable, deserved and a testament to the passion and commitment of our aged care members who have campaigned for them over many years.

Less impressive for aged care is the recent report of the Aged Care Taskforce, which in our opinion, failed to address the quality of care and workforce issues that are fundamental for the sector. The Taskforce failed to adequately address the need for greater financial transparency from providers.

The Royal Commission into Aged Care Quality and Safety provided many examples of the profitability of aged care to the expense of vulnerable residents and workers. In our view the Taskforce recommendations will not improve the workforce shortages across the sector, nor will it address the quality of care being received within the facilities. There needs to be greater financial transparency from providers.

This is a totally reasonable ask when 75 per cent of aged care funding comes from taxpayers. The current reporting requirements are still too opaque to see where this funding is being spent.

Time for a reset on pay

The success of the work value case in aged care has encouraged the ANMF to pursue a similar case for the Nurses Award on the basis that nurses and midwives’ work has never been properly valued. If successful, the application would ensure the recognition of work value given to nurses and AINs in the Aged Care work value case, will be extended to all award-covered nurses, midwives and AINs with the 15 per cent just the beginning.

It will also contend that award rates are set too low, stemming from the historical, gender-based undervaluation of nursing and midwifery care work. Better pay for nurses and midwives in all sectors is not just about fairness, it is about necessity. It is also achievable. Cost of living pressures have been biting working people hard for some time.

The results of a recent inquiry initiated by the ACTU and chaired by former Australian Competition and Consumer Commission chair Professor Allan Fels have been insightful about the origins of this crippling inflation.

Professor Fels found most of the inflation observed in the wake of the pandemic was a consequence of price gouging by corporations, particularly energy companies and supermarkets. His findings are consistent with international research that challenges the economic orthodoxy that says inflation begins with higher wages that are passed on to prices.

When workers ask for improved wages, this is often thrown at us by employers, governments and media. It no longer washes. Household costs have been soaring in other areas too as our investigations into housing affordability among nurses and midwives have found. Exorbitant rents and crippling interest rates for homeowners are hurting many of our members.

And in this tough environment the government has been startlingly insensitive by introducing parking fees for patients and staff. The cost-of-living crisis is part of the context in which we have put our proposed claim for a 15 per cent pay increase in the Public Health System for members to consider.

The other part, of course, is the need to recruit and retain the workforce we need to implement safe staffing ratios. Nurses and Midwives have been uncomfortable about talking about pay. But love for the job can’t pay the bills and we need to speak up and talk about what we are worth. As aged care has showed, when we do this, the evidence is on our side, and we win.

A foundation but more to do

February 15, 2024 by Madeline Lucre Leave a Comment

The rollout of ratios is complex and at every step we will need to be vigilant, but phase one delivers significant improvements while giving us a strong platform to campaign robustly for further progress across the entire system.

Members have just finished voting on a plan that constitutes phase one of the roll out of ratios throughout the public health system.

That plan is the culmination of more than eight months of negotiations between the Ministry of Health and the NSWNMA.

We were cautious about moving to that first phase because we wanted to make sure the implementation of ratios is successful. The details of the roll out were expected to be published in October, but we continued to push for improvements that we thought were necessary.

When we reached the point that the Ministry would no longer negotiate, we felt that it was the appropriate time for public sector members to collectively express their will on whether to accept or reject the plan.

This first phase was endorsed by your 23-member NSWNMA Council in December because they believed the ratios proposal from the Safe Staffing Levels Taskforce would bring about “a shift-by-shift staffing system that is transparent, accountable, and enforceable for the first time in NSW, and will create a strong foundation as we campaign to have other specialties included”.

In phase one, our emergency departments will get the significant increase in staffing they desperately need, with some set to benefit from upwards of 20 to 50 additional FTE under the reform.

A, B, and C peer group hospitals will see their NHPPD wards and units convert to shift-by-shift ratios, ensuring that the complex averaging of staff numbers is gone and the correct numbers of staff are provided on each and every shift. Many wards will also see critical improvements to the number of supernumerary in charge roles.

All patients requiring critical care in ICUs and HDUs will be nursed by an RN, except in Level 4 ICUs where ENs currently employed will continue to be counted in the 1:1 or 1:2 ratio and additional access nurses will see many ICUs able to receive the vital support they were seeking.

A STRONGER COMPLIANCE PROCESS

On balance we think this initial plan provides significant staffing improvements in these areas.

It is instructive to compare these proposed ratios with other states.

In Queensland, specialty areas including ED, ICU and maternity do not yet have ratios.

In Victoria, resus staffing in ED on a morning shift is 1:3 (compared to 1:1 in NSW) and there are no legislated ICU ratios.

It took Victoria 20 years to achieve their level of ratios. We are attempting to overhaul our entire staffing system and achieve comparable ratios to Victoria in a space of less than four years. We should recognise that this is a remarkable and challenging reform to achieve.

An important component of the first phase is a compliance process that is much stronger than what we have been working with till now.

The onus will now be on management, up to and including the ministry, to address any ratio shortfalls in a ward or unit within a 24-hour to 48-hour period, under an agreed escalation process.

MECHANISMS TO PROTECT SKILLS MIX

We know the complexity of the NHPPD system gave management too many opportunities to rort the system. We wanted to see that system overhauled.

Changes to the Public Health System Nurses’ and Midwives’ (state) Award will give additional protections to staffing numbers and skill mix.

These changes ensure that any current staffing profile number and/or skill mix in a ward/unit which is better than what the Safe Staffing Levels Taskforce recommendations call for will be maintained.

Under this clause on any ward or unit where Safe Staffing Levels are implemented:

staffing numbers can’t be reduced
AiNs can’t be introduced into a staffing profile where they don’t currently exist, and
the percentage of RNs can’t be

The existing safeguards such as Reasonable Workload Committees remain, giving us additional capacity to run local campaigns around staffing issues.

The issue of AiNs counted within ratios was a sticking point in our talks with the ministry and has been the source of many concerns voiced to us by members.

While we haven’t got everything we want, the proposed plan does, for the first time, give us a strong mechanism to regulate the number of AiNs on any one shift.

There are about 1800 AiNs currently working in the public health system. If they were all to be counted as supernumerary now, nearly three- quarters of the 2023 budget allocated by the state government for additional FTE nurses would go to replacing these AiNs.

That would greatly reduce the impact of the first phase of the roll out.

It’s clear that we need to continue our campaign for ratios to spread further, and for our entire claim to be funded, we remain committed to that campaign, and we know members are as well..

The SSLT will now focus on phase two, addressing our claim for MPS, Maternity and Level 2 EDs.

Serious health reform is not negotiable

December 1, 2023 by Madeline Lucre Leave a Comment

We must ensure the State government delivers the funding necessary to fulfill its promises on ratios.

In its September budget the new Minns government made a solid start by allocating almost $1 billion for nursing and midwifery positions to help deliver ratios in public health.

The government made an election promise to the people of NSW to deliver safe staffing in emergency departments, intensive care units, postnatal maternity and multi-purpose services. It also promised to convert current nursing hours wards to shift by shift ratios.

The good news from the budget is that there is funding for the 1112 nurses that the previous government had failed to deliver on. These positions are now safe.

On top of that there is funding for 1200 more nursing and midwifery positions that is new.

However that level of funding in the budget will not be enough to roll out ratios in every hospital, ward and unit within the five designated specialties over the next four years.

So there is progress but also a new challenge before us.

Going forward we must ensure that there is sufficient future funding to fulfill the promise to implement ratios across the state.

I would encourage you to have a chat with your local MP about the importance of funding ratios.

Clarity needed around pay

The government’s intentions around pay remain unclear. In the budget they also announced $3.6 billion for wages to essential workers over the next four years. How that money is distributed and what will be allocated to nurses and midwives has not been announced.

Our message to the government is clear: Serious health reform is  not negotiable and nurses and midwives deserve certainty around the resourcing of ratios and significant improvements to their take home pay.

This is a fight we will take right up to the next budget in June. We will have to campaign strongly for Labor to do more in their 2024/25 budget.

There were other positive signs in the budget for health. There was fee relief for student nurses and midwives of $4000 per annum if you commit to working in the public health system, but again, not enough positions are being funded and we question how this will be targeted.

There is also extra funding for women’s health and for more sexual assault examiners.

There is mixed budget news for infrastructure, with further funding for the new Rouse Hill hospital, but existing hospitals like Albury Wodonga being underfunded, leaving communities and staff uncertain about the direction for their services.

Where to from here

We will continue working with the Ministry of Health to facilitate the implementation of ratios through the Safe Staffing Taskforce.

The 2480 positions funded in the budget gives us something to start with. But we know it’s not enough.

We need to engage the government and convince them to provide more funding. We need to approach our local MPs and convince them that more needs to be done.

They need to understand that nurses and midwives will not stop advocating until ratios are implemented in every hospital, community health setting, and multi-purpose service in NSW.

Already some branches have started this process (see pp 28-29). There is a role for everyone in this campaign. I would encourage you to have a chat with your local MP about the importance of funding ratios properly.

Many MPs are convinced that ratios are essential in every specialty and in every hospital if we are to attract and keep the nurses and midwives that the Public Health System so desperately needs.

We also need them to understand that the funding of healthcare should not be seen as inherently bad or burdensome. Properly  funding health services provides a golden opportunity for the government to invest in communities, people and relationships.

“Properly funding health services provides a golden opportunity for the government to invest in communities, people and relationships.”