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April 21, 2021
  • THE MAGAZINE OF THE NSW NURSES AND MIDWIVES’ ASSOCIATION
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Public Health

AHPRA warns against anti-vaccine claims

April 7, 2021 by Rayan Calimlim Leave a Comment

There are serious penalties for practitioners who spread COVID anti-vaccination information, including loss of registration.

In March, the national medical boards and the Australian Health Practitioner Regulatory Agency (AHPRA) released a joint directive warning doctors, nurses and pharmacists against communicating misinformation about the COVID vaccine, either directly to patients, or via social media.

Penalties could include losing the ability to practise.

NSWNMA Assistant Secretary, Judith Kiejda, says the AHPRA warning is timely.

“We have all seen the tsunami of pseudo-medical advice floating around on social media during the pandemic. It has never been more important that we, as professionals, provide our communities with sound advice and model appropriate health-promoting behaviours,” she said.

“The Association is aware that some nurses and midwives are spreading outlandish conspiracy theories from questionable sources on the internet. Nursing and midwifery are professions that are proudly rooted in science. There is no room in our professions for this quackery.”

Experts point out that nurses have professional and legal responsibilities to practice evidence-based medicine.

“Nurses are guided by the ethical and legal requirements of the profession,” says Associate 
Professor Vasiliki Betihavas from the ACU’s School of Nursing, Midwifery and Paramedicine.

“Policy and procedures are developed from the best available evidence [and] it is a requirement that nurses abide by policy and procedures set by governing bodies and local health districts.

“To promote safe nursing practice, critical reasoning is paramount. Safe nursing practice requires nurses to be guided by evidence with continuous evaluation and ongoing critique.”

Be a role model

In light of research suggesting significant levels of hesitancy around the vaccine for COVID-19, nurses have an important role to play in countering misleading and false information, according to Associate Professor Betihavas.

“In Australia, each state has an approved health website. We encourage nurses to refer queries that individuals in the community may have to that website, and to encourage their colleagues to also refer to peer-reviewed literature.”

In a recent interview with the 
ABC, vaccine hesitancy expert Professor Julie Leask, from the University of Sydney School of Nursing, also emphasised the need to listen to people’s concerns. But she advised to 
not “go overboard” arguing 
every point.

“We can all too easily get bogged down in fact-for-fact debates about safety and the vaccines,” she said.

She said it might be helpful to explain to anyone worried about the testing and approval of vaccines that “the trials are very large 
and safety issues are being monitored carefully”.

But she says it is important to acknowledge people may have legitimate worries, and it is best to “avoid overconfidence until we learn more from the vaccine trials”.

She suggests nurses consider acting as an example for anyone concerned about immunisation.

“Right now, it might be enough to say, ‘I plan to get one if it’s recommended for me’ and act as a positive role model.”

Challenging COVID misinformation with the facts

Experts say it is better to challenge misinformation where it appears.

“Rather than demanding the deplatforming of the people who post misinformation, we might instead think of it as an opportunity to correct misperceptions in front of the audiences that really need it,” Adam Dunne, associate professor at the University of Sydney wrote in The Conversation.

Here are some useful websites to find empirically-based information about COVID:

Therapeutic Goods Administration provides regular updates to keep consumers, health professionals and sponsors informed of the latest regulatory developments on COVID-19 vaccines.

https://www.tga.gov.au/covid-19-vaccines

The World Health Organization website contains a lot of easy-to-understand information, including the facts behind a number of Coronavirus myths.

www.who.int/emergencies/diseases/novel-coronavirus-2019

Is it true? This Australian Government Department of Health website provides accurate, evidence-based answers to questions about COVID-19 vaccines: https://www.health.gov.au/initiatives-and-programs/covid-19-vaccines/covid-19-vaccines-is-it-true

The NSW Health website – provides information about the COVID-19 rollout in NSW: www.health.nsw.gov.au/infectious/covid-19/vaccine

 

More education and lower workload for nurses sees patients’ lives saved

March 31, 2021 by Rayan Calimlim Leave a Comment

Hospitals where nurses are qualified to bachelor’s degree level and have lower patient-to-nurse ratios have lower mortality rates.

In a cross-European study published in The Lancet, researchers found every 10% increase in the numbers of nurses with bachelor’s degrees at a hospital reduced patient mortality by 7%.

The researchers at the University of Pennsylvania School of Nursing and the University of Leuven in Belgium also found that every one patient extra added to a nurse’s workload increased the likelihood of a person dying within 30 days by 7%.

“Nurses in hospitals are the surveillance system,” Linda Aiken, professor of nursing at the University of Pennsylvania and the lead author of the study, said. “If nurses’ work loads are too high, they don’t see patients early enough.”

She estimated that if nurses cared for no more than eight patients each, and 60% of them had bachelor’s degrees, hospital mortality following common surgery procedures could be reduced by a third.

The study used discharge data for 422,730 patients aged 50 years or older who had common surgery at 300 hospitals in nine European countries between 2007 and 2009. The research builds upon previous studies in the US and Canada.

Large variation between hospitals

A key finding was the large range of nurse staffing levels within countries. In England, there were an average of 8.8 patients to every nurse, across the 30 hospitals studied. But this varied from 5.5 in some hospitals, to 11.5 in others.

Of the nine countries in the study, Norway had the lowest patient-to-nursing-staff ratio at 5.2 patients per nurse, while Spain the highest, at 12.7.

But in both Spain and Norway all nurses are required to have batchelor’s degrees. At the time of the study, an average of 28% of English nurses surveyed had BAs, below the average of 52.1%. Again, this varied between nurses, from 10% in some hospitals, to 49% in others. However, since September 2013 it has been compulsory for all nurses in England to be educated to degree level.

The results bring into question a decision by the European Parliament in October 2013 to keep open two pathways into nursing. This retained a vocational pathway into nursing across Europe, which means nurses can begin training after only ten years of education in primary and secondary schools.

“No other part of the world accepts less than 12 [years],” Aiken said, adding that it could affect both patient outcomes and nurses’ ability to find work in other parts of the world.

Austerity bites

The research is published within a context of austerity across Europe, in which hospitals are looking to make savings across the board. “It’s very easy to just reduce nurses, because they’re a large proportion of expenses,” Aiken said, but she warned this would be a mistake.

Peter Griffiths, chair of health services research at the University of Southampton who was involved in the study, said that while the results don’t set out what is a safe level of staffing, “it makes it absolutely clear that low staffing levels are dangerous”.

Griffiths said even though a degree level education is now a requirement for nursing registration, there had been a “massive backlash” against it. “In the face of these figures it is hard to conclude that degree educated nurses are to blame for failings in the NHS. More likely, where nursing has failed it is because it has not been adequately resourced and supported by NHS managers in some hospitals.”

The researchers said that the study challenged the view that nursing experience was more important than education, but Cara Bailey, a lecturer in nursing at Birmingham University, said that “it has to be a combination of both.”

“Education and support are hugely important in developing caring, compassionate, competent, courageous and committed nurses,” she said.

“Care of patients who are critically ill is complex and patients can deteriorate rapidly. In today’s hospitals, patients are cared for in a variety of settings outside of critical care areas, so it is imperative that all nurses are provided with the educational support in order to notice cues around deterioration and act upon them appropriately and rapidly.”

“Reduced staffing is no doubt a major challenge but the problems hospital settings are faced with today requires a multifaceted approach that involves education, leadership and resources for support,” Bailey sad.

In England, the compulsory degree education for new nurses has raised concern about the number of nursing students needing placements in hospitals.

Karen Elcock, head of programmes for pre-registration nursing at Kingston University and St George’s, said recruitment on its new BSc Nursing Programme remains buoyant since its launch in September 2011.

However, she said, “The availability of practice placements has always been a challenge and continues to be so. Much of this is due to the significant reconfigurations that have taken place within the NHS.”

In response, St George’s has increased the amount of time students spend on community placements, and opened up new placement programmes with the independent and voluntary sector.

Bailey said that nursing education in England was carried out in partnership between universities and hospital trusts. “While there are some differences among entry requirements for programmes and the structure of curriculum delivery, half of the education programme is spent in practice working with clinical mentors caring for patients, and the other half within university, gaining the knowledge and critical awareness skills that underpin and support nursing practice.”The Conversation

Gemma Ware, Global Affairs Editor and Podcast Producer, The Conversation and Jo Adetunji, Deputy Editor, The Conversation

This article is republished from The Conversation under a Creative Commons license. Read the original article.

High nurse-to-patient ratios put COVID response at risk: study 

March 19, 2021 by Rayan Calimlim Leave a Comment

An American study has concluded that the lack of nurse-to-patient ratio legislation in much of the country has jeopardised their COVID-19 recovery. 

The joint study by the University of Pennsylvania, the Leonard Davis Institute of Health Economics and the National Council of State Boards of Nursing found that high and variable nurse-to-patient ratios in much of the United States left nurses working burnt-out and understaffed – affecting both patient care and staff morale in the early stages of the pandemic. 

The study analysed survey data from nurses and patients in 257 hospitals in Illinois and New York, and compared it to data collected from California, where nurse-to-patient ratios have been legislated since 2004. 

It found that nurse-to-patient ratios varied from 3.3 – 9.7 patients per nurse in medical and surgical wards, while intensive care unit staffing ranged from 1.3 – 3.6 patients per nurse. 

This variability and often large ratio led to over half of survey respondents indicating that they had been suffering from burnout from before the pandemic. Many rated the quality of care at their hospitals as being sub-standard, as did many patients. 

As a result of this burnout, the authors of the study found that many nurses entered the pandemic with mental and physical health issues, which resulted in adverse outcomes for patients and negatively affected the American health response to the pandemic. 

“The COVID-19 pandemic has highlighted shortcomings in US healthcare”, the authors said in their conclusion. 

“Our findings point specifically to the risks posed to the public’s health of wide variation in hospital nurse staffing if allowed to persist. Such risks could be addressed by safe nurse staffing policies”. 

The NSW Nurses and Midwives’ Association is currently campaigning for safe nurse-to-patient ratios to be mandated in NSW. To find out more about this campaign, visit their website.  

 

 

Ratios save lives, at no added cost 

March 12, 2021 by Rayan Calimlim 1 Comment

A US study has found that nurse-to-patient ratios not only improved patient outcomes – they did so at little financial cost to the health system.  

The study, led by Dr Karen Lasater RN PHD, found that hospitals with better staffing levels recouped the added costs of staffing by having significantly lower lengths of admissions and lengths of stay. 

The study analysed readmissions, mortality rates and lengths of stay for patients admitted for acute myocardial infarction, congestive heart failure, pneumonia, stroke, or sepsis at 306 American hospitals. 

After accounting for differences in patient status and acuity, the researchers found a cost difference $18,848 per patient for those in hospitals with proper staffing ratios, versus a cost of $18,671 per patient at those without them. This presented an insignificant cost difference between the two cohorts. 

However, hospitals without staffing ratios exhibited notably higher rates of patient mortality and readmissions. They also had lengthier hospital stays on average. 

In particular, patients admitted for sepsis had a 2% greater mortality rate at understaffed hospitals compared to those who attended hospitals with safe ratios 

The costs of readmissions and hospital stays thus counteracted any financial benefit derived from cutting staff.  

University of Pennsylvania’s Aaron Glickman lauded the results of the study, indicating it as a reason to mandate nurse-to-patient ratios in hospitals. 

“Prior literature made the quality case for better nursing clear. This study bolsters the economic case,” Glickman said. 

“When hospitals invest in their nurses, patients benefit, with no net increase in costs. That’s a powerful value proposition.” 

The NSW Nurses and Midwives’ Association is campaigning for safe nurse-to-patient ratios in hospitals across the state. Learn more about the campaign here.

Government slugs hospital staff again as free parking ends

February 28, 2021 by Gia Hayne Leave a Comment

As nurses and midwives roll up their sleeves for the COVID-19 vaccine rollout, many are angry the NSW Government has been quick to claw back a paid parking reprieve at the state’s public hospitals.

From April, NSW Health will resume charging nurses, midwives and other hospital staff up to $23.60 a week to park at their workplaces.

Brett Holmes, General Secretary of the NSW Nurses and Midwives’ Association (NSWNMA), said the government had been quick to forget the ‘gold standard’ efforts of its own health workforce.

“Despite being on the COVID-19 frontline for twelve challenging months, and the vaccine rollout in its infancy, the government wants to slug nurses, midwives and all other health staff with paid parking at public hospitals,” Mr Holmes said.

“These women and men have barely received a 0.3% increase in their pay and already the government wants them to open their wallets again. It’s a disgrace.

“For some, that’s more than $1,200 a year in parking fees that they’ll need to find within their family budgets.”

During Budget Estimates last Thursday, the government also confirmed it would pursue a new 1.5% wages policy cap through the NSW Industrial Relations Commission (IRC).

“Adding insult to injury, this government is hellbent on suppressing wages growth in NSW. It will drag hardworking health employees through an unnecessary IRC process yet again before agreeing to any pay rises,” added Mr Holmes.

“A punishing wage cap of 1.5% for public sector workers won’t get supported in the NSW Parliament, so the government will spend even more taxpayer dollars pursuing its agenda through the IRC. It’s ludicrous.”

More nurses needed to help curb violence

February 17, 2021 by Rayan Calimlim Leave a Comment

The NSW Nurses and Midwives’ Association (NSWNMA) has welcomed the state government’s long-awaited release of its final report into hospital security, but fears it won’t be enough unless additional nurses are employed.

NSWNMA Acting General Secretary, Judith Kiejda, said many of the measures outlined in the final report were already current policies, but they had not been applied or enforced to better protect staff or patients, and increased clinical staffing should be a part of the solution.

“We’ve highlighted before just how normalised acts of verbal and physical violence have become for nurses and midwives going about their work in our public hospitals,” Ms Kiejda said.

“The government has committed to adopting these additional measures, but they haven’t prioritised the need to ensure our hospitals and health facilities are staffed appropriately, particularly in some of the regional sites.

“In rural and regional areas, our nursing staff are regularly put at risk and this is often compounded by short staffing.

“We agree there is a need for more hospital security across the state, but security personnel cannot be expected to provide the clinical care being sought by patients coming through the front door.

“Additional violence prevention and management training, as well as refresher courses, are welcome measures but you still need the presence of clinical nursing staff to reduce incidents or help to de-escalate situations.

“Extra security is important, but it’s not the only solution that is required. It’s not going to help improve the triaging of patients or reduce waiting times in our emergency departments – the right number and skill mix of nursing staff is essential – as well as proper support for staff to report incidents when they occur.

“Unless the government is prepared to acknowledge this, we fear it will be some time before incidents of violence and aggression towards hospital staff is significantly reduced.

“We need the government to support our nurses and midwives by implementing safe staffing, that can be achieved by mandating nurse-to-patient ratios throughout NSW.

“Victoria and Queensland both have mandated nurse-to-patient ratios in their public health systems, NSW needs to step up.”

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