March 1, 2021

Editorial

Stronger together

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Over the last year strong campaigning by nurses and midwives has kept our high priority issues in front of the public.

We have just completed our 74th annual conference and, as always, it is an opportune moment to take stock of our efforts and achievements over the past year.

The first half of this year was punctuated by a state election and a federal election within months of each other – a true test of our campaigning capacity.

The effort and commitment shown by members and staff during this time was staggering.

In both elections we were driven and energised by a singular goal – the achievement of shift-by-shift ratios in the public health system and in aged care.

While those ultimate goals remain we have still made a lot of progress.

The community is more aware and supportive of our aspirations for ratios. The state government has responded to our campaign with a promise to introduce more nurses and midwives into the public health system. The Labor opposition committed to the introduction of shift-by-shift ratios. And the crisis in aged care has been brought out of the shadows and is front and centre in public discourse.

In his speech to annual conference NSW Health Minister Brad Hazzard generously conceded that the Association’s campaigning and advocacy had played no small part in getting Treasury to agree to fund extra nurses in the public health system and to make improvements in rural and regional hospitals (see p17).

We now have a task to ensure the Liberal-National government delivers the additional 893 nurses and 48 midwives promised over four years, on top of what is required to meet normal growth.

The crisis in aged care is no longer being ignored thanks to relentless campaigning by our members in that sector. This culminated in a heartbreaking expose by Four Corners and the subsequent announcement of a Royal Commission into Aged Care Quality and Safety by the federal government.

We can’t rest on our laurels

These improvements in multiple areas is heartening but we can never rest on our laurels. There are always powerful interest groups who want to push back on any gains we make. No further progress will be made without hard work, sacrifice and the will to fight for it.

We have been effective in the past because of the strength we have in our branches and in our workplaces. But if we want to be even more effective we have to continue to build that strength, to build the power of our collective.

We also have no choice but to engage politically on issues that impact our patients. I understand that for many of our members that is difficult. But we have to recognise that societal issues such as climate change, trade, tax systems and privatisation all have an impact on people’s health.

It is our duty to be aware, informed and engaged on these issues as union members and citizens if our democracy is to be functional and if we want to achieve our goals.

Martin Luther King once said: “The arc of history is long and it tends towards justice.” It is a salient lesson for all trade unionists who are committed to making our society better, including nurses and midwives who are determined to make our public health and aged care systems among the best in the world.

We need to be patient and persistent.

As Mr King alluded, history shows us that comprehensive campaigns that challenge ingrained practices and behaviours in society do take time. Sometimes decades.

It is worth reflecting that this was our 74th annual conference. It is a marker of a long and brilliant history. So much of what is good in our professions and in our health system is a legacy of what nurses and midwives who came before us, fought for.

Now it is our turn to come together, combine our strength, build our own history and to add to that legacy.

Ratios remain our long-term goal

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The NSWNMA welcomes the government’s commitment to fund more nurses in the 2019-20 budget but we still maintain ratios are the key to safe patient care.

First the good news. In the 2019-20 budget, the state government has committed to fund the 5000 extra nurses for our public health system that it promised during the election campaign.

We are still waiting to receive any specific details from NSW Ministry of Health regarding the election commitment to significantly increase resources across Peer Group B and C hospitals across the state.

The increase in nurse and midwife numbers will go some way towards meeting the ever-increasing demand on public health facilities and give a boost to nursing hours per patient in many metropolitan and regional hospitals.

We acknowledge this as a positive contribution and a good first step towards fixing NSW’s creaking public health system.

But much more needs to be done. We still believe there will be ongoing staffing issues in our public health services until the government overhauls its 
preferred staffing model.

The current mechanism has proven fallible to management manipulation. It requires constant action by nurses and midwives to force management to act to fill glaring shortfalls in staff.

In this month’s Lamp we look at several examples of nurses closing beds in order to get local managements to act on, or at least to acknowledge, the data that exposes the failure to meet increasing demand with appropriate resources.

This is why we will continue our long-term campaign for real nurse-to-patient ratios, guaranteed shift by shift.

We know that without minimum nurse-to-patient ratios, nurses and midwives will continue to struggle to meet demand and maintain safe patient care.

There were other measures in the state budget which should put nurses and midwives on the alert. The government flagged that it will axe almost $3.2 billion from other areas of the public service, with thousands of jobs to go and aspects of long-service leave entitlements on the list to be abolished. Fortunately, for now, the upper house non-Government members voted down the government’s first attempt to enact these changes.

But it is not unreasonable to ask: “When will they be coming for our long-service leave again?”

The scourge of violence persists

Ratios are not only needed to improve clinical safety in our health system they are also, at least, a part of the solution to the endemic violence in our hospitals.

In this month’s Lamp we look in depth at the unresolved crisis of violence that continues to jeopardise the safety of patients and health staff (pp 16-25).

Over the years there have been a procession of inquiries, reviews and roundtables that have failed to make a dent in the number of violent incidents.

Research by Dr Jacqui Pich from UTS has shown the magnitude of the problem with massive numbers of nurses and midwives exposed to violent incidents on a regular basis. Frighteningly, there is a tendency to accept and adapt to the violence as “part of the job”. A recent incident at RPA when three nurses and an elderly patient were attacked and stabbed with a pair of scissors by a mental health patient, but within a medical ward, threw into stark relief the seriousness of the problem.

The attacker had been specialled by an agency AIN, a situation the Association strongly believes was inappropriate.We understand that the issue is complex and there is no silver bullet to the problem of violence.

But one can argue that penny pinching by local managements contributes significantly to this crisis by failing to provide the right number of nurses with the right training to deal with violent emergencies.

Reports in other states have recommended adequate funding and resources to counter violence in hospitals. Having the appropriate number of staff with the right skill mix is an obvious part of the solution.

We choose fairness not fear

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The federal election result is a setback for the union movement but the issues and problems we have highlighted in aged care, public health and with workers’ rights are not going to just magically disappear.

There is no sugarcoating it – the federal election result was a blow for the union movement. As a movement we campaigned on issues relevant to our members. Those issues required a change only offered by progressive political parties and in the end the Australian electorate chose not to change.

Although it was disheartening we must be clear – the federal election outcome was not a referendum on our issues.  Significant parts of the community listened to fear and chose tax cuts instead of fairness for all.

There is an important lesson for us in the outcome: it will require a lot more work to turn around 40 years of inequality and trickle down economics. The changes we need will not be achieved in one election cycle.

During the federal election campaign, not enough union members believed things had become bad enough to change the government or they didn’t believe that it could be changed. This means our work must continue.

We have to continue because there is no choice. Too many Australians – young and old – depend on us for their health and welfare and it is our duty to advocate for them, to stand up for them and to fight for them.

Nowhere is that clearer than in aged care. In this month’s Lamp we report on the hearings of the Royal Commission into Aged Care. There are the findings of the ANMF National survey and another report into aged care conducted by the NSWNMA. There is a damning analysis by a prominent, well-respected specialist in geriatric medicine.

All these accounts reinforce what we have been saying publicly for some time: aged care is in a severe crisis. It has been in crisis for over a decade and things are getting progressively worse. It is a crisis that cannot just be wished away. Fixing the crisis requires action by a government that cares about the elderly as much as we do.

We have to salute and support the NSWNMA members who fronted up to the Commission and gave personal testimonies from the frontline about the dire state of the sector. It tool real courage and it is obvious from the comments of the Commissioner that they made a difference. He was effusive in his praise of these brave nurses and their constructive contribution.

We are building support for better aged care

While the federal election was an opportunity to get our perspective out to the community it never defined our aged care campaign. It is much bigger than that.

Irrespective of the election result tens of thousands of people are more aware of the need for better staffing in aged care. Our campaign led to a royal commission, an admission from the government of non-compliance and failures in the aged care sector and the attention of the media and a country that is ready to support real change.

That is a solid base from which to continue our crusade for a better deal for our elderly.

The other issues we have campaigned on aren’t going away either. Wages stagnation remains a serious issue for our economy and as an obstacle to fairness in Australia.

The climate change emergency intensifies with each day without action and our health system remains woefully unprepared without a health and climate change strategy.

The public health system remains underfunded, understaffed and under resourced.

None of these issues are going away and neither are we. Although the outcome in the election was not what we wanted our strength and capacity as a union has grown for being in the fight.

And we are going to use that increased strength and capacity to continue the fight: for our members, for our patients, for the elderly, for public health, for aged care.

That is what we are. That is what we do.

An opportunity to change the rules

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Australia needs policies and an economic direction that deliver a better life for working Australians.

The federal election to be held on 18 May will have significant consequences for nurses and midwives. At stake for NSWNMA members are fairness in the workplace, a better deal for aged care and the proper funding of our public health system.

The NSWNMA is committed to the ACTU campaign to “Change the Rules”. The goal of this campaign is to restore fairness for working Australians. Currently the laws are unbalanced and give employers too much power. They are also increasingly recognised as a drag on our economy.

The changes unions are seeking – transforming the minimum wage into a living wage, tackling casual and insecure work, investing in health and education, bolstering retirement incomes, tackling climate change and making our tax system fairer – are essential and urgent if Australia is to remain prosperous. And they’re essential and urgent if the benefits of that prosperity are to flow through to all Australian workers.

Changing the rules to make the workplace fairer would have a direct impact on nurses and midwives working in private hospitals and aged care.

The rules around bargaining and the rights of workers are currently loaded in favour of employers. The make it difficult to get better wages and staffing including the winning of ratios.

Employers are given the power to stop listening to unions and to shut down bargaining. They prevent nurses and midwives in private hospitals and aged care from achieving significant improvements because employers have the upper hand. They limit the capacity of nurses to use industrial pressure. Already we are hampered with 6 procedural steps that we must undertake before we can take industrial action.

The aged care crisis is a national disgrace

As we have reported time and again in The Lamp aged care is in crisis. The large companies that dominate the sector have been allowed to put their profits before care even though billions of taxpayers’ money prop up the system.

Nursing care has been diminished for financial gain and the trends are for worse. The ANMF and the NSWNMA have put forward concrete measures to improve care in the sector and to make providers accountable and transparent.

We want to see changes that will “Make Ratios in Aged Care Law Now”. We know staff-to-resident ratios are the solution. Legislated staffing ratios in aged care will ensure nursing hours are mandated for each resident.

Equally our public health system needs more support from the federal government. This Liberal National government started its term in office with a horrendous budget that slashed health spending – the consequences of which are still being felt to this day.

Bafflingly for health experts and health economists, the biggest cuts came in the areas of preventative health and community health – widely acknowledged as the most cost effective ways of delivering health care.

Neoliberalism has run its course

We also need a change in the economic direction of the country.

For some time now major economic institutions have been ringing the alarm bells about the direction of the Australian economy.

They been warning, with increasing urgency, that tackling inequality and poor wage growth are fundamental to strong economic performance.

These conservative institutions realise that the world has changed and the neoliberal economic direction that has dominated developed economies for the last 40 years has run its course.

In aged care and public health, as in the economy and social policy there has to be change. The federal election we face on May 18 gives 
us the opportunity to bring about that change.

The ACTU has been very clear in its message to union members about what is required to get the country back on track so workers and their families get a fair go: we need to change the rules and to do that we need to change the government.

It is hard to argue with that logic.

Our campaign will still deliver more nurses and midwives

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Now that the Liberal National Coalition has been re-elected in NSW we will need to keep them honest about their commitment to fund more nurses and midwives in the public health system.

As The Lamp goes to press the Liberal National government has just been re-elected in the NSW state election.

The tireless efforts of nurses and midwives during the election campaign resulted in the Association achieving unprecedented commitments from both major parties in the lead up to Saturday’s state election.

 The Labor Party committed to a comprehensive ratios plan that matched our analysis of what was needed for the NSW public health system so much so that we for the first time, advocated a vote for Labor as the only way to achieve this strategic goal. The Liberal– National Coalition committed to an extra 890 nurses and midwives above already budgeted growth, leaving the distribution up to the Local Health Districts and the current Nursing Hours Per Patient Day model.

While they did not go as far as Labor in committing to shift-by-shift ratios in law, their published policy says it will deliver an additional 893 nurses and 48 midwives over four years on top of those required to meet normal growth.

We don’t believe this is nearly enough but I believe it has only occurred as a result of members campaigning for ratios.

Members have told us not to stop until we achieve ratios on all shifts, city and country, so we will continue to campaign for safe staffing and a new ratios system. Without shift-by-shift ratios in the Award, we will need to enforce the current nursing hours per patient day formula to ensure it functions in the spirit in which it was first promised – as a ratios equivalent. We will need to be vigilant and assertive to ensure those extra nurses and midwives do end up at the bedside.

While working with a Liberal– National government will be challenging for us, it will not be insurmountable. We welcome the opportunity to continue working with any government on behalf of our members and for the interests of the patients they care for.

I want to send out a big thank you to all those NSWNMA members who volunteered during our campaign. Your hard work, support and dedication did not go unnoticed by the major parties and, as a result, nurses and midwives are recognised as a force to be reckoned with.

Do not feel disheartened. Remember, Governments come and go, but nurses and midwives always remain the backbone of the public health system and we will continue to campaign for safe patient care no matter who is in office. We do so because we know it is in the best interests of our community and of our members. I thank each and every one of you who have supported the campaign. We are a stronger union for your efforts.

Let’s make ratios in aged care a federal election issue

In this issue of The Lamp we give you a report on the proceedings of the Royal Commission into Aged Care and we also look at other federal election issues that will impact on nurses and midwives.

The Royal Commission has heard a lot of uncomfortable realities about the state of the aged care sector. They have also been given this key insight from multiple sources: that the presence of registered nurses is critical in aged care while the declining role of RNs is the biggest issue for the sector.

This was a message that was strongly emphasised by academics and doctors as well as the ANMF. Annie Butler, the ANMF federal secretary, spent more than two hours giving evidence to the Commission. She described the “untenable” workloads faced by RNs, ENs and AiNs which is forcing them out of the sector.

We want aged care to be a prominent issue in the federal election and for all parties to commit to ratios in aged care.

I urge you to join our campaign to Make Ratios Law in Aged Care a federal election issue.

Please go to www.ratiosforagedcare.com.au and register your support.

Shift-by-shift ratios are within our grasp

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This state election is crucial if we want to win shift-by-shift, nurse-to-patient ratios across the entire public health system.

As The Lamp goes to print the NSW Labor leader Michael Daley has announced that if he is elected to government on 23 March he will move immediately to introduce 
shift-by-shift nurse to patient ratios throughout the NSW public health system.

Labor’s plan is comprehensive and incorporates the vast majority of claims we have been campaigning for over the last decade and more.

The strength of Labor’s plan is in the detail.

Labor has promised to staff our medical, surgical and paediatrics wards, our emergency departments and our postnatal maternity units using the ratios model.

This will require funding of an extra 5500 nurses and midwives over the next four years.

Labor had already agreed to extend 1:3 ratios into paediatrics and emergency departments and to bring regional staffing levels up to city levels. In themselves these were major improvements that would make an enormous difference to improving 
the system.

But now they have gone much further. They have promised to introduce 1:3 ratios in maternity wards, provide additional staff for specials in medical and surgical wards and make improvements in community health and community mental health. When there are uneven numbers in the calculation of ratios, the number of nurses rostered will be rounded up.

Labor’s plan should be music to the ears of all public health system nurses and midwives in this state. It is what we have campaigned so hard for, on behalf of our patients and our professions, for so long.

Michael Daley was gracious enough to say to an audience of Tweed health service members at the launch of his policy that: “I want to say to nurses and midwives – this is your win, this is your campaign.”

Numbers are transient, ratios are permanent

On the cusp of the NSW state election the Liberal-National Coalition has belatedly changed its position on nursing and midwifery numbers. They have promised to fund 5000 extra nurses and midwives over the next four years and we acknowledge that.

But, as welcome as the Government’s announcement is, it doesn’t go nearly far enough.

Nurses and midwives know from hard experience that management are manipulating the numbers to circumvent the provision of enough nurses to deliver safe care. We have seen that in hospital after hospital, across the state, over many years. We have seen patients missing out on thousands and thousands of hours of care they were entitled to.

That is why we stand by shift-by-shift ratios as the policy solution that will guarantee safe nurse to patient numbers. Labor now agrees.

Both Labor and the Liberal-National Coalition have come to this election with vastly improved policies about public health that have more nurses and midwives at their core.

That owes everything to the fantastic activism of nurses and midwives the length and breadth of the state over a long period of time as we have taken our knowledge and analysis of what is happening at the frontline to the NSW public.

Our campaign has established the undeniable fact that nurse-to-patient ratios saves lives and put it at the heart of health policy.

Wages, workers comp, aged care and privatisation are important too

There are other issues in this election that are important to us as clinicians and union members.

The wage freeze on public sector workers including nurses and midwives – now in place for eight years – has to end.

The workers’ compensation system that was so ruthlessly dismantled by this government when it first came to office has to be rebuilt so injured workers are given the support and afforded the respect they deserve.

NSW must have a requirement for nursing homes to have an RN on duty around the clock.

And last, but not least, we are totally opposed to the privatisation of our public health services.

For all of those members in aged care, private hospitals and elsewhere it is worth considering that improvements to our public health system are a personal benefit to everyone who may need care. Importantly, standards set in public health help win the argument for the same conditions elsewhere.

When it comes to voting on March 23 I would urge you to give a high priority to all these issues and how the respective party policies will impact on your jobs and the care we can deliver to our patients.

In particular I would urge you to consider what it would mean to finally have shift-by-shift ratios implemented in our public health system across our state.