October 9, 2026

Editorial

We need to defend our wins

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As The Lamp goes to print, the NSW Safe Staffing Levels Taskforce has announced that medical, surgical and palliative care wards across every category A, B, and C hospital will convert to shift-by-shift nurse to patient ratios.

This is a massive milestone in our long-standing and hard-fought campaign to improve workloads and deliver quality patient care. This win belongs to members and while we celebrate the win, we must not rest.

The NSW Government is yet to meet its initial commitment to the remaining NHPPD wards, ICU, MPS and Level 2 EDs. Our work now is to hold them to account to deliver more. We won’t rest until we have secured ratios in every specialty area.

Our fight for ratios in the private and aged care sectors must also continue. Nurses, midwives and carers everywhere need safe workloads. This is the driving force behind the ANMF’s national aged care campaign.

There has been undeniable progress in the aged care sector, but the actions of some employers shows that we can’t rest on our laurels.

Some aged care providers manipulate care minutes to maintain their profits at the expense of care. So, we need to push for further reform.

The lesson for us is clear – whenever we get a win, we need to make sure that those wins are defensible and can be progressed. That requires action at the workplace, with our communities, and in our parliaments.

In aged care we have entered into a national campaign with the ANMF to build on the solid foundations of our previous campaigns and to move on to the next stage to improve the lives of our elderly and our dedicated members who care for them.

A comprehensive national survey of aged care workers by the ANMF shows the sector still suffers from widespread understaffing, increased workplace violence, cost-cutting and a lack of transparency for billions of taxpayer dollars (see page 6).

The campaign calls for:

  • mandatory staffing ratios and skills mix across all shifts to replace the current care minutes system
  • adoption of a 10-point plan to better protect nurses and care workers from physical, verbal and emotional violence
  • public reporting of providers’ financial performance and use of $25 billion in public funding.

Aged care shows us that employers can find a way to undermine progressive reform, and we need to be resolute in enforcing it. We are holding employers and governments to account, and we must do so again, and again, and again.

Plenty of work ahead of us

We are faced with similar challenges in all parts of the public health system from maternity services to mental health.

There have been decades of government neglect, the constant squeezing of the public sector for “efficiencies” and chronic underinvestment in the workforce.

The consequences were predictable: unreasonable workloads, inadequate pay, professionalism unrecognised, career paths not established, and the rising costs of tertiary education pushed back on the workforce.

In response to these decades of neglect is the need for workplace planning to provide a pipeline of midwives and specialty trained nurses to meet the needs of a sustainable public health system. Workforce planning requires a long lead time.

This is why our work in implementing ratios across the public sector has been so important, and why we must continue to fight.

It is going to take a focussed and concerted effort to rebuild the midwifery and nursing workforces.

It will require more students who get the right support, experience and knowledge as they train.

It will require the right pay, sustainable workloads and effective retention strategies to attract and retain more people to our wonderful professions.

Establishing ratios in our Level 3 to Level 6 Emergency Departments has provided positive change. Aged care has shown us that with patience, courage and stamina we can make radical and positive improvements to our workplaces for the benefit of our communities. But the journey is never simple. Employers or governments can prioritise their self-interest and push back or stall reforms even when they are self-evidently needed.

This is the work of unions. We fight for improvements, and even when we win, we must continue fighting – to enforce what we have won and to improve our rights, our workplaces and our professions even more.

To do this we need to be organised and strong and have a united voice as we go forward.

Listening to members is key to delivering better care

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Our members have always known what works. Ratios and new workforce research now provide further evidence that listening to nurses and midwives delivers better outcomes for everyone.

One of the great privileges of this role is seeing members campaign for change, then watching that change begin to make a real difference in their workplaces. For years, our members told governments that ratios would improve patient care, reduce pressure on nurses and midwives and help retain experienced staff in our public health system. We never stopped making that case because our members never stopped making it to us.

Today, we are beginning to see those years of campaigning paying off. The rollout of 1:3 nurse-to-patient ratios in Emergency Departments is already changing the way care is delivered. Members are telling us they have more time with patients, they’re getting their breaks more consistently, and they’re able to provide the standard of care their patients deserve.

Equally as important, members are reporting that the benefit of ratios extends beyond the day-to-day, it impacts the profession as a whole; workplaces are once again transforming into environments where staff want to build long-term careers.

Our members knew what ratios would achieve long before governments accepted the evidence. Ratios have never just been about numbers on a roster. They are also about creating the conditions for nurses and midwives to deliver safe, high-quality care. There is still more work ahead. While the rollout is continuing into general medical, surgical and specialty wards, we will continue advocating until every commitment made to members by Labor has been delivered, including for nurses and midwives working in our Intensive Care Units and Multi-Purpose Services in regional communities. From these five we will build; every member deserves to work in a safe, properly staffed workplace, regardless of where they practise.

This edition of The Lamp also features the Choice, Voice and Control report, and in many ways it tells the same story. Compiled by Professor Rae Cooper AO and her team from the Centre for Gender Equality and Inclusion @ Work at the University of Sydney Business School, the report draws on the experiences of more than 2,000 public sector nurses and midwives across NSW.

The findings offer irrefutable evidence that a lack of choice, control and flexibility in the current workplace design is unsustainable, with 56 per cent of nurses and midwives reporting they often had to stay at work after their shift ended, 82 per cent agreeing they had too much work to do, and 54 per cent saying they did not have an adequate work-life balance.

By speaking up in Professor Cooper’s report, members have articulated what needs to change to futureproof our profession. They want manageable workloads, genuine input into their rosters and working hours, supportive managers and workplaces that recognise nurses and midwives have families, caring responsibilities, and lives outside work. Most of all, they want to feel heard.

These are not unreasonable expectations, they are the foundations of a sustainable health workforce. One of the strongest messages from the report is that flexibility works best when it works for everyone.

Nurses and midwives need genuine choice, voice and control over how they work, while continuing to deliver excellent care to patients. That kind of flexibility is only possible when staffing levels are safe and employers listen to the people providing care every day.

That is why these two stories belong together: ratios reinforce what happens when governments listen to nurses and midwives, and the Choice, Voice and Control report highlights where we need to keep listening. Together, they provide a clear roadmap for building a stronger and more sustainable health system.

Ultimately, every major improvement our members have secured has come through collective action. Better wages, safer staffing, improved conditions and stronger workplace rights have never been handed to us. They have been hard won because members organised, stood together and refused to accept that things could not change.

There will always be more work to do, but the progress we are seeing today is a reminder of what is possible when members speak with one voice. As your union, we will continue listening to our members, campaigning alongside them and making the case for a health system that values the people at its heart. Because when members are listened to, patients receive better care, workplaces become stronger and our public health system is better for everyone.

Invisible skills now visible, but wages are stuck in the past

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The NSW Industrial Relations Commission agreed that nurses and midwives have been historically undervalued because of gender, but female-led workforces must still pay the price for the state’s shaky bottom line.

For well over a century, the nurses and midwives of this state have transformed the landscape of care, evolving clinical practice into a high-stakes, technical science. Every day, our members navigate a world of complex pharmacology, life-saving technology, and acute clinical decision-making, expertise that was once unimaginable. 

And yet, while the clinical reality of your work has moved into the future, the industrial value assigned to it remains anchored in the past. 

When the Industrial Relations Commission (IRC) awarded a three-year wage deal from 1 July 2025, including 16% for Registered Nurses and Midwives, 18% for Enrolled Nurses and 28% for Assistants in Nursing and Midwifery, the decision was rightly met with mixed emotions from our members. 

The wage increase for Assistants in Nursing is fantastic and well overdue. However, for Enrolled Nurses, Registered Nurses and Midwives, who make up the overwhelming majority of our impacted workforce and are predominantly women, it is not enough to make up for decades of gendered wage suppression. 

Following the decision, Health Minister Ryan Park labelled it “historic,” and he’s right, inasmuch as it is a reminder of the historic undervaluation that hinders feminised labour. Amongst NSW public sector workers, entry-level nurses and midwives are paid less than teachers, police and firefighters (often by margins of 10%-20%). 

In handing down the ruling, the court agreed the work value of nursing had been historically undervalued, principally because it involves the exercise of caring or interpersonal skills, often referred to as “invisible skills.” The IRC also noted that while the visible skills of registered nurses have been recognised, the invisible skills have been consistently overlooked. 

In a witness statement tendered during the case, Professor Rae Cooper AO, a leading expert in Gender and Employment Relations at the University of Sydney, explained why. 

“These skills are often treated as ‘natural’ to women rather than specialised,” argued Cooper. “Which has led to them being excluded from, or valued less in, job and skill evaluations and in classifications in awards and other instruments.” 

As Professor Cooper established, categorising clinical care as a “natural capacity” of women renders that work economically invisible. Subsequently, the IRC agreed that a one-off increase was necessary to address the possibility that your work is undervalued for gender reasons, but with the caveat that any conclusion must consider the government’s fiscal position, as required by the legislation. 

For members, this felt like a case of the more things change, the more they stay the same. Once again, you were being asked to shoulder the burden of the state’s bottom line. 

Compounding the issue is the reality that the gender pay gap continues to worsen (most recently sitting at 7.3% in 2025, up from 6.2% in 2023 and 4.5% in 2022) under the Minns’ Labor government; a worrying sign considering that same government is the largest employer of women in Australia. 

As of June, 66.6 per cent of the 478,303 public sector employees were women, with nursing boasting the highest number of female employees. 

Rather than using the size of your workforce as a scapegoat, the government should seize the opportunity to actually listen to the issues being tabled by its largest cohort of employees. 

We know that nurses and midwives feel overworked and undervalued, with workloads and pay regularly cited as the most common reasons for leaving the industry or moving interstate. But the welcome news is that we’re making headway on both fronts.  

After more than a decade of campaigning, staffing ratios will finally be introduced across medical, surgical and specialty wards – the next stage of the nurse-to-patient ratios rollout – delivering well overdue workload relief for members. On pay, the IRC’s confirmation of gender undervaluation provides us an inarguable platform to build from as we fight to improve wage conditions in the future.  

We will never stop advocating for the NSW Government to pioneer a budget for a health system that values your work. We remain committed to finding solutions that make a difference to our members today, tomorrow and into the future. 

The power of the people is stronger than the people in power

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Two of our most crucial core values – collectivism and courage – were on display as members made themselves heard – achieving significant wins in two major hospitals. 

One of the great joys of this position is watching passionate members demand change for the greater good. Collective action is an intrinsic part of our DNA and seeing branch members coming together to spotlight maintenance issues at Newcastle’s Calvary Mater Hospital is a great example. 

Calvary Mater in Newcastle is one of the state’s busiest cancer hospitals. Despite being a major public health hub for the region, nurses endured months of water leaks in wards, mould outbreaks in the ICU, and maggots falling from the ceiling. Deeply concerned not only by what was taking place but also by the refusal of management and the Novacare consortium responsible for maintenance and repairs to address the issues, the branch formally escalated concerns, citing risks to staff and immunocompromised patients. 

The branch passed resolutions demanding transparency, lodged a Section 81 safety process, and repeatedly pressed management and the Novacare consortium for answers. When maintenance delays persisted and accountability remained unclear, the branch organised a major rally in their own time that drew more than 100 staff. Spotlighting the issue gave our members a platform to connect directly with their local community, ensuring that patient and worker safety were at the forefront.

Following this, the government promised to engage an independent contractor – separate from the public-private partnership – to manage building works. This action generated widespread media coverage and prompted the Minister for Health to intervene, fast tracking cladding replacement. Their advocacy also helped drive a parliamentary inquiry into PPP management and hospital maintenance failures. 

This has been one of many recent examples where members have organised and used provisions of the Work Health & Safety Act to achieve change. Not for the first time, the courage of branch members established a safe channel for staff to speak up and pressured authorities to act. As a union, we will continue to campaign for system wide maintenance reforms across NSW hospitals. 

Another PPP bites the dust as NBH goes public

The saga of the Northern Beaches Hospital will finally come to an end with the transfer to public hands scheduled for 29 April 2026. While this is a welcome move, the failure of another PPP provides further proof that quality health care is compromised when profits are prioritised over patients. The Association campaigned strongly against the PPP when it was announced, and staff have shown incredible resilience and unity while navigating a turbulent time.   

On the plus side, nurses and midwives will be covered by a generally more favourable public health system award, but the consequences of Healthscope’s collapse are not over yet. The union maintains that this transition must not unfairly disadvantage nurses and midwives who have given many years of loyal service to the community, and who strongly support the provision of public health services.  

We continue to assist with issues relating to tax, a dispute over cashing out excessive leave, and a potential reduction in annual leave for part-time workers. 

NSWNMA offers visa help to overseas recruits

I am especially proud of how the NSWNMA has helped achieve a major win for overseas-recruited staff employed by Healthscope on short-term visas. The decision by the NSW Government to take over NBH immediately put at risk the visa status of approximately 80 internationally recruited nurses and midwives on Healthscope-sponsored “skills in demand” 482 visas.

The Association engaged with Health Minister Ryan Park to ensure visa sponsorship was transferred to NSW Health and Northern Sydney Local Health District and later advised all NBH visa holders that NSW Health would take over management of their 482 visas.  

Welcome new workplace reps

A big congratulations and welcome to our new branch officials and delegates following the conclusion of the Biennial General elections. These elections are essential to the democratic nature of our union and crucial in ensuring each workplace has a voice in the union’s direction. We can’t wait to see the incredible work you will do representing your branch over the next two years. 

New challenges, new fights

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The world never stands still, and neither can the Association if we are to achieve our goals.

The hearings for our Special Case wrapped up in December and we now await the findings from the Industrial Relations Commission (IRC). The full bench of the IRC indicated that our decision will be handed down in the first quarter of this year.

I would like to thank our legal team for the tremendous job they did. Thanks also to the 37 members who bravely shared their experiences with the IRC providing strong evidence of the realities of work in the contemporary healthcare environment (see p14). We are also grateful for the expert witnesses’ evidence that allowed us to put forward the strongest case possible.

They all did a fabulous job representing our professions, giving voice to our members’ claim for a pay rise that values the work they do and that addresses the historical gendered undervaluation of that work.

Regardless of the outcome of the special case, which will be final and binding on all parties, the fight for improvements in wages and conditions has to remain a constant focus for our union. Our determination to win improved wages and conditions for public sector members doesn’t stop with this decision.

The economy continually evolves with changes in inflation, productivity and the cost of living all impacting on the buying power of your wages.

Similarly, new circumstances constantly arise in our workplaces. Our Special Case highlighted the significant changes in the scope and complexity of nursing and midwifery work over recent years, partly as the result of COVID-19, evolving professional standards, and changes in the complexity of patient care.

There will inevitably be more changes. Healthcare is a dynamic sector and will continue to face new challenges whether they be due to the health consequences of climate change, the outbreak of new pandemics, improvements in technology and artificial intelligence, or other, yet unknown, developments.

We need to be prepared for any new challenges and ensure nurses, midwives and carers are rewarded for their role in meeting these challenges.

The work members do is incredibly important for the functioning of our society. They improve the health of our communities and make our economy stronger as a result.

They deserve pay and working conditions that reflect their contribution and allow them and their families to have a good quality of life while they are working and in retirement. As a union, we need to remain strong and united to ensure we win for members.

CARE MINUTES ARE THE UNFINISHED BUSINESS OF AGED CARE

Despite the enormous progress we have made in aged care in recent years there is still work to be done.

Decades of campaigning by our aged care members led to the Albanese government investing $16 billion in the sector.

That massive investment of taxpayers’ money was allocated to improve the care of residents, not to swell the profit margins of providers.

The clear feedback we are getting from our members in the sector (see p8) is that many providers are falling well short of their obligations to provide mandated care minutes.

This is backed up by research conducted by the NSWNMA and is even evident in providers’ own self-reporting.

The Association will continue to campaign for stronger requirements for transparency and more robust mechanisms for accountability around care minutes and the presence of RNs 24/7. We will also hold employers to account where care minutes are being erroneously allocated to non-direct care.

The Albanese government deserves credit for its commitment to the sector but without improved measures of accountability it risks endangering the progress we have made.

THE FIGHT AGAINST HATE AND BIGOTRY

The terrorist attack at Bondi, a clear act of antisemitism, surely makes it clear to all that it is crucial that we fight against hatred and bigotry, and stand strongly for peace, love and unity.

As a progressive organisation we embrace the fight against racism in our community: the racism experienced by Aboriginal and Torres Strait Islander people and all people of colour, the rise in anti-Semitism and Islamophobia, these must all be countered. This is something we have to urgently address.

In recent years we have implemented measures to ensure greater diversity in the voices that are heard within and from our union. Now we are reaching out to like-minded allies in the health and aged care sector to ensure our workplaces are safe as we fight against racism; if we do this work together we will have an impact not just at work, but within our communities.

I’m proud of the work that we’ve kicked off in collaboration with the Human Rights Commission (see p24). Curbing the right to protest is not the answer. Solidarity, education, and support for each other within our workplaces is the best way to influence our communities and rid our society of racism.

Nursing in the blood

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The Lamp introduces our new Assistant General Secretary Katrina Bough who talks about her journey to leadership.

Katrina comes from a family steeped in nursing.

“My mum and my grandma had long careers in ED nursing and midwifery,” she says.

“I grew up sitting around my grandmother’s table, surrounded by nurses who were her colleagues and friends listening to their stories and was always in admiration of their profession. So, when I started my training, during my very first placement, when I sat in a tearoom for morning tea, it felt like sitting in my grandmother’s house. I felt very comfortable, almost like I was at home.”

“In my early 20s, I decided nursing was what I wanted to do. I had three small children when I started my nursing journey.

“My grandmother used to travel up from Sydney to stay at my house so that my husband and I could both go to work because it was difficult with three children under the age of 10.

“I used to take my son to uni lectures when he was three or four, and he would sit and watch videos on a portable DVD player. Or in a tutorial, he would sit under the desk and play with his little figurines. He became a bit of a classroom favourite.”

A STRONG UNION ENVIRONMENT

Both her mother and grandmother were union members “and my grandfather was a very staunch union man”.

“He worked on the wharves. He was a clerk. He was very supportive of workers and their rights. He taught me a lot about being part of a collective and the camaraderie of being union.”

“And then when I started working and did my orientation and started working shift work, it became really apparent to me the importance of having that camaraderie on the floor. I worked in a unionised workplace where pay and conditions were discussed openly, so being in the union felt natural and an important part of everyday life.”

Katrina says the thing about nursing she loves are the relationships with other people.

“When I started nursing, I spent a lot of my time focusing on my clinical skills. Working with people at their most vulnerable times, it is so important to be kind, compassionate and a really effective communicator. I worked in general surgical, then I went to ED. I worked as a casual for a long time so that I could work everywhere, from ICU to rehab to geriatrics. I often mentored nursing students and loved watching them succeed. I moved into Clinical Facilitation for my local University so I could continue to develop undergraduate nursing students to have job ready clinical skills and found this to be so rewarding.”

“I loved nursing, and I still love it.”

At the heart of this love affair with the profession is the relationship with nursing colleagues, she says.

“You always see nurses walking in groups. You’ll see nurses walking to lunch in pairs or threes or fours. There’s that sense of camaraderie that you finish when everyone finishes, and you all get your bags and walk out together, and that kind of collective ‘I’ve got your back’. You celebrate together. You do everything together.”

A KEY WORKPLACE LEADER IN OUR EPIC FIGHT AGAINST PRIVATISATION

Katrina cut her campaigning teeth in the fight against the privatisation of five rural and regional hospitals – including Wyong Hospital – announced in September 2016 by the then Liberal health minister, Jillian Skinner.

At the time Katrina had been the President of the Wyong branch for one week.

“It was really the beginning of my leadership journey. Wyong was a bit of a sleeping giant. It had a lot of Union members but hadn’t been super active. The campaign really activated the members of that hospital.

“I learned so much from that campaign. I learned how to engage the community, how to engage my peers, how to talk to MPs.

“We had conversations with the community; we did letterbox drops. A colleague created a Facebook page – ‘Wyong loves its public hospital’ – and we grew that page to have 13,000 supporters.

“We talked to community members at market stalls, and we did petitions. We put in the legwork, and we had conversation after conversation so that people understood what a risk the privatisation was.

“The community started out disappointed but then they became angry. The land had been purchased by coal miners and then gifted to build a hospital. People felt betrayed by a government that was going to sell a community hospital to make money or reduce health care services in a lower social economic area.”

When the government backflipped on the privatisations, “it was overwhelming, exciting”, she says.

“I just remember sitting on the floor in the kitchen and I started crying because it had been 15 or 16 months of campaigning every weekend, after every shift with community events. It was really the nurses that drove that campaign.”

TIME TO IMPROVE THE LIVES OF NURSES

Katrina says when her father passed away, the timing felt right to move into a new space and away from bedside nursing and that the Association seemed like a good vehicle for improving the lives of nurses and midwives.

“It felt like the natural move to come and share my newfound skills with my fellow nurses and midwives across the State. I wanted to help care for the people who care for the people!

“I’ve learned that the thing that brings me most joy and the thing that excites me is seeing nurses and midwives find their voice and understanding their rights, and exercising them in a way that’s productive and effective for them.”

“My new responsibility is to ensure that the members have a really bright future in nursing and midwifery. I want to work with them to do that, whatever that looks like to them that nurses have control over their own destiny in their workplace and in life.”

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