July 10, 2020

Editorial

Shift-by-shift ratios are within our grasp

by

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.

Chronicle of a fiasco foretold

by

Normally it takes a bit of time before the flaws and inadequacies in service provision from a privatised public service become obvious but at the Northern Beaches Hospital it has been on show from the beginning.

The privatisation of the Northern Beaches Hospital was undertaken without any serious public debate. The tendering process was shrouded in secrecy. The public was lied to about what it would cost. Now the hospital has opened in a state of chaos due to completely inadequate planning and preparation.

This is largely due to a failure to engage with staff and a management that lacks experience in running public hospitals. It was arrogant to think  that private corporations would do a better job of running a public hospital.

The government responsible for this debacle deserves to be made accountable.  

The opening six weeks for the hospital was a shambles as we detail in this edition of The Lamp and as was heavily reported in the media. The Government and Healthscope were obviously embarrassed but tried their best to spin it as “normal teething problems”, despite the large number of problems exposed.

Nurses, midwives and other health staff have done their very best to deliver a service to their community against almost impossible odds. Privatisation was the wrong decision and we said so loud and clear from the beginning. The Baird/Berijiklian Government has locked in this privatisation for the next 20 years at least. Unwinding this would cost a lot of money and we have to make sure this mistake is not repeated.

Healthscope needs to deliver on its contract and meet its obligations to deliver appropriate staffing and maintain the entitlements of the transferred nurses. It needs to negotiate nurse-to-patient ratios in the next round of bargaining.

I am advised that Healthscope at Northern Beaches is currently pulling out all stops to recruit new staff and in the interim is relying on more than a hundred agency RNs per day to fill the rosters.

Interestingly, many are travelling from Western Sydney and pass public hospitals like Nepean, Blacktown, and Westmead – all of whom swear on a bible they can’t find RNs to fill their vacancies and that agencies can’t help them. Northern Beaches Healthscope is obviously more successful than our public hospitals when it comes to the supply of agency RNs!

Since it was elected to office in 2011 this NSW Liberal-National government has made the privatisation and outsourcing of public services, including health, its signature policy.

Electricity, ports, housing, land and property information, recreation facilities, museums and court operations are just a small sample of the many services that have been subject to its sweeping privatisation program.

And, of course, health services have not been exempt. On top of the Northern Beaches Hospital there was the privatisation of disability services and the attempt to privatise five regional hospitals.

The privatisation of public hospitals and health services was undertaken without any consultation or discussion with the community about what it wanted.

The NSW public was denied the facts they needed to make an informed choice on this issue at the last state election. Very soon they will have the opportunity to rectify that, better armed with the facts, including the facts on the ground.

The Labor leader Michael Daley has pledged that if his party is elected to government: “There will be no privatisation of NSW hospitals, water, electricity or public transport services”.

Nurses and midwives, along with the community, will have a clear choice on this and other critical issues for public health when the NSW state election rolls around this March.

Labor sticks to its pledge on ratios

by

The NSW Opposition has changed its leader but its policy on ratios remains the same.

The new NSW Opposition leader Michael Daley has quickly moved to re-commit his party to deliver new nurse to patient ratios if it wins office after the next state election in March.

Mr Daley re-committed Labor to:

  • Introduce a new shift-by-shift ratio system from 1 July 2019
  • Introduce 1:3 ratios in emergency departments and pediatrics
  • Bring regional staffing levels up to city levels
  • Work to fix the specialling problem.

These commitments are completely consistent with Labor’s previous announcements.

This means we still have a clear pathway to ratios in our public health system that would reward many years of campaigning and advocacy by nurses and midwives to the benefit of patients.

The opportunity for new ratios remains alive and real in our public health system.

This continuity shows ratios are clearly embedded in ALP policy and are not dependent on any individual who may lead the party.

It reflects the strength of our arguments and the weight of evidence that shows ratios save lives and improve patient care.

In addition to the implementation of comprehensive shift-by-shift ratios, Michael Daley has also committed to an extra 250 security staff with additional powers that “will be placed in NSW hospitals to protect staff, patients and families”.

The NSW government has also announced an initiative to assess the threat to safety in our public hospitals.

The Minister for Health, Brad Hazzard, has appointed Peter Anderson, a highly respected former Health and Police Minister, to review the impact of the 12-point plan on hospital security, established in 2016, and to consider any additional strategies to improve safety.

These measures from both Labor and the government are welcome in light of a new study conducted by researchers at the University of Technology, Sydney (see pp 10-11).

This comprehensive survey showed that there are alarming levels of violence against nurses and midwives across the entire health system.

Twenty four per cent had suffered physical violence. It is worth digesting that sentence more than once. A quarter of nurses had been the victim of physical violence in the course of doing their jobs delivering care.

As the researcher who conducted the survey said: This makes the job more dangerous than that of the police and prison officers.

Not only is the violence widespread, it is getting worse. Three quarters of nurses and midwives who responded to the survey believe the frequency of violent episodes was increasing.

There are many complex reasons why violence has become endemic in our health facilities. But it cannot be ignored that understaffing leaves nurses and midwives more vulnerable to aggression.

Labor’s promise to increase nursing and midwife numbers along with the deployment of more security and the government’s review of safety won’t solve this problem alone.

But they are a very good place to start.

Thanks for your ongoing support

The Australian Electoral Commission recently announced that Judith Kiejda and I have been re-elected unopposed following the closure of nominations for the ANMF NSW Branch Secretary and Assistant Secretary positions (along with Branch Councillors).

This also means that we have been re-elected to the NSWNMA General Secretary and Assistant General Secretary positions.

We are both grateful for your ongoing support for our leadership of your unions. Much has changed since our first election in 2003 and we have had to lead that change.

Politicians have chosen to remove your traditional industrial rights and we have had to encourage you to engage with the politicians who, ultimately, are the decision makers. Most members understand the reason for doing things differently.

We now face a further attack from the State Government that is trying to restrict our capacity to engage in the political debate as third party campaigners.  We are relying on the High Court to give your public voice back so that your issues can be widely heard by the community in the lead up to elections.

Should the High Court decide otherwise – and in favour of politicians with their loud and dominating voices – then our union will have to make further changes to meet that challenge. We will ensure your voice is never silenced when it comes to advocating for safer patient care.

It is a great privilege to lead the ANMF NSW Branch and the NSWNMA. We do not take that for granted. Judith and I thank you for your support.

Our first shift-by-shift ratios victory

by

A well-organised, hard-working branch along with an enlightened employer has delivered an agreement with NSW’s first shift-by-shift ratios.

Hats off to our Macquarie University Hospital branch. After months and months of negotiations and perseverance as part of the bargaining team they have achieved a memorable enterprise agreement which delivers shift-by-shift ratios for the first time in NSW (see pp 8-11).

This is a major breakthrough – not just for the staff at Macquarie – but for nurses and midwives throughout the state.

Management at Macquarie recognised our arguments that implementing such ratios are better for patient care. Interestingly, they are also good for the hospital’s business model.

Macquarie competes with a number of other private hospitals within a small radius and this agreement will allow it to attract the high quality staff and provide them with the resources they need to deliver high quality care that will make the hospital competitive in a crowded market. 

This is a salient lesson for other private hospitals, those running our public hospital system as well as providers in aged care. Ratios should be seen as an investment that will enhance the quality of health delivery rather than as an expense.

There are other notable achievements in the Macquarie University Hospital agreement: a good pay rise, 12 weeks paid parental leave, five days paid family and domestic violence leave and improved qualification and on-call allowances.

Our members at Macquarie believe this will give them a better work-life balance. The employer will get a more contented and motivated workforce. Patients will get safe, high quality care.

This is a win-win outcome that we would like to see other employers pursue.

Aged care needs a sea change

Enlightened isn’t how you would describe many of the large aged care providers. Blinkered would be more apt. Blinkered by the bottom line of their financials.

You would think that after the barrage of recent negative media coverage that has ranged from the ABC’s Four Corners to the Daily Telegraph over the poor staffing, poor care and outlandish profiteering that plagues the aged care sector that providers would take stock and show some humility and remorse.

But not so. As we outline in this month’s Lamp some of the country’s biggest providers continue to pursue a business model that is underpinned by staff cuts despite the clear evidence of what the consequences of that will be.

As the NSWNMA and ANMF have been saying for some time, now vindicated by media exposure, these cuts inevitably lead to poor care.

Taxpayers would have good reason to feel aggrieved knowing that billions of dollars in government money going into aged care is being channelled into profits and executive bonuses rather than for care for Australia’s elderly.

This money needs to be accounted for more vigorously. The last federal Labor government, in its final days, tied extra government funding to wage increases for aged care workers. Unfortunately, the incoming Abbott government – in one of its first acts on gaining office – reversed this innovative policy.

But the idea that aged care providers should be made accountable for how government funding is allocated remains a strong one.

The media revelations and the ongoing behaviour of aged care employers give little confidence that providers will allocate this government funding responsibly towards more staff, better skill mix and adequate care without being forced to do so.

There is a mountain of empirical evidence that shows ratios enhance safe patient care. Nurse to resident ratios enforced in law should be a vital cog in ensuring accountability in the aged care sector. 

Sexual Harassment Must Be Prohibited Under Industrial Law To Drive Real Workplace Change

by Leave a Comment

NSWNMA Assistant Secretary, Judith Kiejda, outlines why sexual harassment at work should be considered a safety issue in order to make real change.

It’s a year since the stories of now-disgraced Hollywood producer, Harvey Weinstein first began to hit the headlines.

#MeToo spread like wildfire, fuelled by stories of lecherous bosses, creepy colleagues, and lingering customers. The campaign gave us a moment of solidarity, but it also showed us that despite having legislated against sexual harassment three decades ago it remains alive and well.

Before #MeToo a comfy assumption had settled in that things had improved. Sexual harassment was considered a thing of the past – a chauvinist boss in an office thick with cigarette smoke leering at the young typist or patting the bum of the tea lady.

Yet Bureau of Statistics data indicates one in two women, and one in four men, will be sexually harassed in their lifetime. And the bulk of it happens at work.

Obviously this is a problem that disproportionately affects women, and while there are complex gender politics issues at play, I approach this problem primarily as a unionist: If we want to address sexual harassment we must treat it as a health and safety issue and explicitly outlaw it under industrial law.

The legal definition of sexual harassment has remained stable over the years. In short, it is unwelcome conduct, of a sexual nature, where it is reasonable to assume the person on the receiving end would be offended, humiliated, or intimidated.

Judith Kiejda is the Assistant Secretary of the NSWNMA, and the President of Unions NSW.

It need not necessarily be malicious behaviour, and while some claim this bans flirting, the assumption is people should be able to recognise when their attention is unwanted and the recipient is uncomfortable.

The current system puts the onus on the victim, because it is seen as an anti-discrimination issue rather than a safety issue. It is costly, slow, and reactive.

The way employers typically handle complaints is informal, temporary, and targeted at the immediate problem, rather than the systemic one.

Employers have no obligation to prevent their workers being harassed. While policies, procedures and training are commonly in place, they are clearly not delivering the shift in the culture we need.

Worse still, those who complain are often victimised. An Australian Human Right Commission study found 43 per cent of those who made a complaint were ostracised, victimised, ignored, or coerced to resign.

Of course, most do not complain. Nor will those who witness it.

Yet if we continue to treat sexual harassment prevention as an exercise in compliance we are effectively reducing it to a meaningless gesture.

There are simple ways this can and should change.

Currently, SafeWork NSW classes bullying as a health and safety issue and refers it to Fair Work. This is not the case for sexual harassment. That means sexual harassment complaints can’t be pursued within the no-costs jurisdiction of the Fair Work Commission.

SafeWork NSW instead sends sexual harassment complaints to the AHRC, which has limited scope to investigate them. Complainants are unlikely to see a result, because under anti-discrimination law there are no penalties for those who harass others. Essentially, there is little incentive for employers to take action to prevent sexual harassment.

This skews the system toward those who can afford to pay legal fees, and have the strength and energy to pursue a complaint through the courts. Unions NSW is calling on government to reform the Fair Work Act to explicitly outlaw sexual harassment.

We should also reform Work Health and Safety legislation to explicitly include sexual harassment as a health and safety risk that employers and the regulator have an obligation to prevent and manage.

This obligation would require employers to take active and positive steps to prevent and reduce the risk of sexual harassment, firmly shifting the burden away from individuals needing to report and deal with sexual harassment.

Unions should be empowered to investigate and prosecute breaches of sexual harassment legislation. The feeling of degradation it brings to those who experience it can be pervasive and inescapable.

We no longer accept unsafe workplaces. Sexist, bigoted, and degrading behaviour should be considered just as intolerable under industrial law.

Share your nursing experiences by emailing us at nurseuncut@nswnma.asn.au

Persistence pays

by

The state of the aged care sector is a national disgrace and our arguments for change are beginning to gain traction.

Aged care nurses have been campaigning for years to change the abysmal state of our aged care system and their persistence has finally been rewarded with a number of significant developments.

Firstly, the media has finally listened to their concerns and cast a spotlight on the dangerously low staffing levels, the poor practices and the profiteering that is rife in the sector (see pp 8-9).

Last month, Four Corners broadcast a very harrowing account that exposed a major crisis in our aged care homes. The Daily Telegraph also conducted a comprehensive investigation into aged care which revealed a shocking abuse of taxpayers’ money by some major aged care providers.

This has had political consequences with Prime Minister Scott Morrison calling a Royal Commission into the state of aged care.

The Four Corners report was very distressing. It was hard to watch these elderly, vulnerable members of our community suffer due to inadequate care, without proper food and without access to the most basic of needs like continence pads.

The brave family members and staff that spoke out deserve our admiration and support.

For many nurses these revelations were not news. 
Aged care nurses, the NSWNMA and the ANMF have worked tirelessly for many years to bring these conditions to light.

We have commissioned research, lobbied politicians, held rallies, run advertising campaigns, taken to social media and talked to the community in a myriad different ways about the terrible state of aged care.

It is a relief that finally these efforts are beginning to stir a response.

The public responds with fury

And the response by the community to the Four Corners report was telling.

The Four Corners Facebook page was awash with caustic comments about aged care providers and their weak explanations for the poor state of care in their homes.

More than 36,000 people voted in an online poll in the first three days after the program went to air. Ninety seven per cent said minimum staff to resident ratios should be enforced in aged care facilities.

This is highly encouraging. The public instinctively understands that the lack of staff is central to the problem and minimum staff-to-resident ratios are an important part of the solution.

The response of the federal government was also telling. Even before Four Corners had gone to air the government preempted the fall out by calling a Royal Commission.

The crisis in aged care certainly warrants a Royal Commission. Society has a moral obligation to stop this neglect and abuse of the elderly.

But there have been decades of reports and inquiries outlining the problems and issues in aged care and any findings of a Commission and the federal government response must go beyond more talk to action.

Addressing the glaring staffing problems remains the overriding challenge.

Aged care providers receive billions of dollars in taxpayer-funded subsidies yet there is no law to guarantee that public funding goes directly to the provision of care.

The NSWNMA and the ANMF have championed a safe staffing law that guarantees safe nurse-to-resident ratios in our aged care facilities. We will remain resolute pursuing that goal.

There is still some way to go to achieve our goals so we must keep up our campaign. The tenacity shown by our aged care members has gotten us this far and we must keep it up.

It is a lesson for us all, in all of our campaigns.

Making substantive change in health and aged care always seems impossible until it is done. But if we show tenacity, resolve and courage we know there is a public out there that supports us and governments that fear that public support.