January 29, 2022

Public Health

Tamworth nurses and midwives pleas for support go unanswered

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 As the state’s health system is put under immense pressure from the growing Omicron outbreak, nurses and midwives at Tamworth Base Hospital are frustrated their calls for safe staffing levels in their emergency department (ED) continue to go unanswered.

In late December an open letter from staff was sent to the Hunter New England Local Health District (HNELHD) Area executive, highlighting the fact that Tamworth Hospital currently has 19 full-time equivalent (FTE) nurse vacancies within the ED and there is not enough nursing staff to fill the base nursing roster.

Within 24 hours of the open letter being circulated, over 200 staff at the hospital signed on, desperate to resolve the staffing crisis. To date there has been no response from HNELHD.

Tamworth Base Hospital NSW Nurses and Midwives’ Association (NSWNMA) Branch Secretary, Jill Telfer, said staff are at a loss as to how they can be expected to continue working in such difficult conditions.

“The ED is relying on nurses regularly doing overtime or part-time staff working extra shifts – it is not sustainable,” Ms Telfer said.

“Nurses receive multiple texts each day, asking if anyone can work extra shifts because there just aren’t enough staff on the roster.

“Treatment is being delayed – this week some patients were waiting for over 11 hours to see a doctor. On average, there is about a 6 to 8 hour wait time for non-urgent patients.

“We’re in this situation because the NSW government is refusing to listen to nurses and midwives’ concerns about long term understaffing.

“The NSW government can resolve this staffing crisis by implementing shift-by-shift nurse-to-patient ratios across the public health system to ensure nurses and midwives can deliver safe patient care.”

Matt Cartan, Tamworth Base Hospital NSWNMA Branch President, has urged the Tamworth community to be understanding and not take out their frustrations on hospital staff.

“Our members are concerned for the safety of each other and for the people of Tamworth and we ask anyone who presents to our ED to be understanding of the wait times,” Mr Cartan said

“Nurses are doing all they can to provide care to patients but working short-staffed feels like you’ve got one hand tied behind your back.

“Many shifts just have to make do working short. It’s not safe for staff and it’s not safe for patients.

“Just next week, we already know there’s currently 31 unfilled shifts. And that’s before any sick leave is taken. Our community deserves better.”

The NSWNMA’s campaign for nurse-to-patient ratios on every shift help to address this issue. Mandated ratios would ensure staffing was adequately linked to the number of patients in a ward or unit, rather than just to the number of beds typically open. Safe workloads will help improve staff retention and recruitment.

 

Public health employee information for COVID-19

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The NSW Nurses and Midwives’ Association is providing support and advice to any members seeking information regarding the novel coronavirus (COVID-19).

Join the NSWNMA to ensure you’re covered at work.

If members are concerned their employer is not following these guidelines, the NSWNMA can provide assistance to ensure appropriate measures are in place. Contact us.

Click here for the latest Workforce Advice for NSW Health staff

Click here for the latest WHS Advice for NSW Health staff

As the COVID-19 outbreak continues to grow, it’s important you know your rights and entitlements when it comes to special leave, sick leave and workers’ compensation. The following information applies to nurses and midwives working the NSW public health system.

Check out our Public Health Sector Webinar- COVID-19 and Leave Entitlements Webinar below.

Paid Special Leave provisions for employees (pandemic leave)

With respect to COVID-19, paid special leave of up to 20 days in total may be granted to employees who are unable to work because they are:

  • Self-isolating in line with public health advice due to being a COVID-19 contact (if not symptomatic and not COVID-19 positive)
  • Caring for family members sick with COVID-19
  • Caring for family members due to closure of school/daycare
  • Unable to attend work due to transport disruptions or workplace closure
  • A vulnerable health worker who following completion of a risk assessment is unable to be redeployed to a lower COVID-19 risk environment and is unable to work from home or self-isolation.
  • COVID-19 Vaccination in the particular circumstances described below

Special leave is paid at the base rate (excluding allowances and penalty rates) and should be made available to you before other forms of leave.

After the 20 days total paid special leave has been used, your employer may grant additional NSW Health special leave on a case-by-case basis. If you’ve exhausted your 20 days special leave and you require further special leave, please apply through your employer in the first instance.

Paid Special Leave for casuals

Casual employees are generally not entitled to paid special leave. If a casual is required to self-isolate due to close contact COVID-19 exposure in the workplace, each situation should be considered by the Health agency on a case-by-case basis including such things as:

  • length of the casual engagement and
  • Whether the casual has regular and systemic shifts

Paid special leave may be appropriate for shifts which are already rostered during the self-isolation period.

Paid Special Leave for Vaccination for COVID-19

Health agencies will continue to make arrangements to support employees to access the COVID-19 vaccination whilst on duty, where it is possible to do this and with the need to ensure service delivery is maintained.

If an employee receives the vaccine and experiences an adverse reaction, they may access paid sick leave entitlements. Where sick leave is exhausted, Agency heads may grant special sick leave on a case by case basis.

Employees that receive a COVID-19 Booster vaccination on or after 7 December 2021 are eligible for a special leave payment of two hours per COVID-19 Booster vaccination if unable to be undertaken in work time.

Leave due to COVID-19 positive test

If an employee is sick due to COVID-19 or any other reason, current sick leave entitlements and conditions apply. This includes situations where an employee is:

  • Self-isolating on paid special leave and becomes sick for any reason; at that point the employee should transition onto sick leave.
  • Symptomatic (including a temperature with/ without other symptoms) and requires testing for COVID-19. Sick leave is applicable for the period from where the staff member becomes symptomatic; through to testing and until a negative COVID-19 test result is received by the staff member, regardless of whether the staff member becomes asymptomatic during the period.

Where sick leave is exhausted, your employer may grant additional sick leave on a case-by-case basis. If you’ve exhausted your sick leave due to COVID-19 and you require further sick leave, please apply through your employer in the first instance.

Please read on in case workers compensation rights are applicable to you.

Workers Compensation

If you have contracted COVID-19 and transmission is likely to have occurred in the workplace, you are entitled to make a claim for workers compensation. There is currently a law in place that health workers are presumed to have contracted the virus at work or while working (something the NSW Government is trying to overturn), it should be workers compensation. Whilst you may be placed on sick leave initially, this should be recredited when your workers compensation claim is accepted.

For advice on what steps to take if you believe you are eligible for workers’ compensation, please read the Workers Compensation section found on this page.

Isolation exemption

On 31 December, the NSW Health Minister signed an exemption to the Public Health Order in an attempt to alleviate widespread staffing shortages across the healthcare system.

Under the change, asymptomatic workers in public and private hospitals who are close contacts of a positive COVID-19 case will be allowed to leave self-isolation and return to work, if they are identified as critical to the service.

This decision is not without risks.

The NSWNMA has urged the Ministry of Health to ensure all necessary steps are taken to protect staff from further exposures.

The rise of COVID-19 cases in the community and in health workers is clearly compromising staffing capacity across the hospital system. The Ministry of Health, guided by the Public Health Unit and the Clinical Excellence Commission, have made these decisions with brief consultation with the health unions.

The NSWNMA will continue advocating for the safety of nurses and midwives but we also recognise your safety and that of your patients is dependent on safe staffing levels, which are clearly unable to be supplied in the current circumstances.

Risk Matrix

NSW Health has updated risk escalation and guidance documents that provide advice for health care workers who have been exposed to COVID-19 in the community or while in the workplace. You can view the latest advice on the Clinical guidance and resources page.

If you have been exposed in the workplace, then your exposure will be assessed based on the PPE you were wearing at the time of the exposure, the nature of the contact and your vaccination status. Further information about how the assessment is made can be found on the NSW Health “Health Care Worker COVID-19 Risk Assessment Matrix” which you can find here.

If you have any questions or concerns about how the matrix works, please contact the Association.

Management of Heat Stress: Outdoor COVID-19 testing clinics

Working in heat can be hazardous. Your employer has an obligation to ensure your safety at work, this includes doing everything reasonably practicable to make sure that you are not exposed to harm from working in heat.

The NSWNMA made representations to NSW Health to ensure risks associated with working in hot conditions are managed appropriately, especially important for nurses working in outdoor COVID-19 testing clinics, where PPE requirements compound the risks of dehydration and heat stress.

NSW Health have since shared resources with Local Health Districts to make sure all appropriate steps are followed. Please refer to the following documents from the NSWNMA, SafeWork NSW and NSW Health:

If you have concerns the measures put in place to protect you from heat stress are inadequate or not being followed correctly, please contact the Association.

COVID-19 testing during paid work hours

The Ministry of Health has advised the NSWNMA that the up to two hours of paid special leave (at base rate of pay) to facilitate vaccinations (C2021-14 Employment Arrangements during COVID-19) will now be made available and extended to booster vaccinations for all government sector workers.

This special leave applies for a COVID-19 booster vaccination received on or after 7 December, 2021.

COVID-19 testing during paid work hours

Wherever possible, NSW Health agencies will facilitate the opportunity for affected NSW Health staff ​​​​​to undertake the required COVID-19 testing during normal working hours.

  • Where the COVID-19 test is available at the site where the staff member usually works, NSW Health agencies will facilitate the opportunity for employed staff to undertake the required testing during a rostered shift or normal working day wherever possible.
  • Where the COVID-19 test is only available at a site that is not the staff member’s usual work location, NSW Health agencies will facilitate wherever possible the release of staff for part of their rostered shift or working day to undertake the required COVID-19 testing at a site where it is available.
  • Where the NSW Health agency determines that neither option listed above is possible, employed staff who attend for the required testing outside of normal working hours will need to be paid for such attendance.

Personal Protective Equipment (PPE)

For detailed advice on PPE, visit this page.

Administration of COVID-19 vaccine

To access FAQs on administering COVID-19 vaccines, click here.

Vaccine preparation and procedure

A number of resources have been developed to support clinicians in the process of preparing vaccines, including labelling requirements. These have been developed separately for both of the vaccines:

Vaccination in work time

Ministry advice is that vaccination for health workers should occur in work time, although it is recognised that when scheduling the second dose it may not align with rosters issued for that day or if scheduled for three months time when the roster is unknown. The Ministry preference for the second dose to occur in work time (rostered shift) but in any event is to be treated as paid time if this is not possible.

Expanding the vaccination workforce

In advice issued 28 June 2021, the NSW Chief Health Officer expanded the classification of registered health professionals who can now assist in administering COVID-19 vaccinations at designated hubs, under appropriate supervision, and provided they have completed identified training. Such professionals will be engaged and remunerated at their relevant classification rate.

This decision makes it possible for certain health professional students to be engaged as ‘Vaccination Workers’ and hired as casuals under the Public Health System Nurses’ and Midwives’ (State) Award. Rates of pay for these staff will be determind by the Ministry.

The Statewide Protocol for the Supply or Administration of COVID-19 Vaccine sets out the framework and protocol for the supply and administration of vaccines that encompasses this additional workforce.

​As stated by the Ministry of Health, healthcare workers considered for prioritisation in Phase 1a of the vaccination program include:

  • Ambulance and patient transport staff
  • Emergency department staff
  • Critical care ward staff (ICUs and HDUs, ECMO and medical retrieval teams)
  • COVID clinic and COVID testing staff (public and private)
  • COVID ward staff
  • COVID immunisation clinic staff
  • COVID pathology lab staff (public and private)
  • Workers at the Special Health Accommodation facility

Vaccination position statements and supportive evidence

As professional leaders in this area, nurses and midwives can find the NMBA’s position statement on vaccination here.

Ahpra’s position statement on Registered health practitioners and students and COVID-19 vaccination is available to view here.

The National Boards and Ahpra have published a joint statement to help registered health practitioners and students understand what’s expected of them in giving, receiving and advising on and sharing information about COVID-19 vaccines. It can be viewed here.

The ANMF’s policy on vaccination is here.

ANMF Evidence on the COVID vaccine is here.

International Staff Travel for Recreational Purposes

Australian State and Territory borders are subject to varying degrees of quarantine or self-isolation requirements as a result of the COVID-19 pandemic. If you have been outside Australia in the previous 14 days and return to NSW, you must not go to any high-risk settings, such as aged care, disability care, healthcare, and correctional facilities until you receive a negative result from your day 7 test.

If you choose to travel overseas; regardless of the COVID-19 status of the destination, you will not be granted for example some form of paid special leave to cover your exclusion from the workplace upon return to New South Wales. Staff returning from private overseas travel will need to negotiate access to their own leave entitlements for the 7 day period.

Vulnerable Staff

The Australian Health Protection Principal Committee (AHPPC) considers that, based on the limited current evidence, the following people are, or are likely to be, at higher risk of serious illness if they are infected with the virus:

  • Aboriginal and Torres Strait Islander people 50 years and older with one or more chronic medical conditions
  • People 65 years and older with chronic medical conditions. Conditions included in the definition of ‘chronic medical conditions’ will be refined as more evidence emerges. The most current list can be accessed on the Department of Health website
  • People 70 years and older
  • People with compromised immune systems (see Department of Health website)

AHPPC recommends that where vulnerable workers undertake essential work, a risk assessment must be undertaken. Risk needs to be assessed and mitigated with consideration of the characteristics of the worker, the workplace and the work. This includes ensuring vulnerable people are redeployed to non-customer based roles where possible. Where risk cannot be appropriately mitigated, employers and employees should consider alternate arrangements to accommodate a workplace absence. In this case, those workers should be able to access the paid special leave (for COVID-19).

AHPPC recommends that special provisions apply to essential workers who are at higher risk of serious illness and, where the risk cannot be sufficiently mitigated, should not work in high risk setting. (AHPPC advice, 30 March 2020)

There is limited evidence regarding the risk in pregnant women. Currently there is no evidence of an increased risk of miscarriage, teratogenicity or vertical transmission of the COVID-19 virus. There is a possibility of an increased incidence of premature birth but there is insufficient evidence at this point in time. The Royal Australian and New Zealand College of Obstetricians and Gynaecologists recommends that, where possible, pregnant healthcare workers be allocated to patients, and duties that have reduced exposure to patients with confirmed or suspected COVID-19 infection.

Further information on PPE

Further information for private health nurses and midwives

The NSWNMA will continue to provide further updates for members as we receive them. Contact us here.

Delta disruption hurts already strained health system

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​​​​​​New data shows emergency department (ED) clinicians have continued to persevere through demanding circumstances inside the state’s public hospitals, after facing one of the busiest quarters for life-threatening ‘Emergency’ (triage category 2) presentations on record.

The latest Bureau of Health Information (BHI) report has revealed more category 2 patients arrived at EDs, and also waited longer for their treatment, than during any other July to September quarter since the BHI began reporting 11 years ago.

As a result, the NSW Nurses and Midwives’ Association (NSWNMA) has repeated calls for the NSW government to introduce mandated nurse-to-patient ratios, which would ensure safe patient care inside a health system already strained by record patient numbers and fatigued workers.

NSWNMA General Secretary, Brett Holmes, said the July to September figures gave further insight into the precarious situation health staff, including nurses and midwives, were constantly in.

“The data speaks volumes regarding the urgent need to resolve ongoing staff shortages inside our public hospitals. Health staff have gone to extraordinary lengths to deliver care, particularly in challenging circumstances due to the Delta outbreak,” said Mr Holmes.

“It should ring alarm bells when a record number of patients, who are increasingly unwell, are not able to be treated urgently in an ED. The workplace pressures this situation puts on nurses, and other health staff, is immense and unsustainable.

“The number of positive COVID-19 patients admitted to hospital rose noticeably during July and August and continued until hitting a peak in the second half of September, when there were also more patients requiring intensive care and ventilation.

“This is in addition to the longest average length of stay recorded for patients admitted to hospital.

“The NSW government has a responsibility to take action to support nurses and midwives, and make sure our community receives the highest quality care in the appropriate amount of time.

“Nurses and midwives have been pleading with the NSW government to introduce minimum nurses-to-patient ratios for years, and this latest data reinforces the need to address this urgent staffing crisis.”

Mr Holmes said it was important to acknowledge the efforts and professional skills of nursing staff who managed the care of community patients inside Special Health Accommodation (SHA) during the Delta peak. The number of SHA patients increased ten-fold during the July-September quarter.

Staff exhaustion blamed for 7 year old girl’s death 

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An independent report into the death of Aishwarya Aswath has found that nurses were “exhausted, demoralised and relatively isolated” on the day of the 7 year old girl’s death. 

The report, released by the WA government on Tuesday, indicated that staffing was “sub-optimal” at Perth Children’s Hospital where Aswath died. It also criticised the hospital’s procedures in a number of areas, including parental communication and escalation supports. 

It recommended a swathe of 30 recommendations, including around policy, staffing and recruitment.  

The Australian Nursing Federation (WA Branch)’s secretary, Mark Olson, indicated that the findings of the report were indicative of the health crisis in WA. 

“I can’t think of a single public hospital that doesn’t have the same problems that are identified in this report,” Mr Olson said. 

“We’re setting ourselves up for the same circumstances that created the tragic death of Aishwarya.” 

The WA Heath Minister, Roger Cook, has pledged to accept and act on the recommendations of the report.  

First Aboriginal COVID-19 vaccination milestone reached, but a gap remains

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First Aboriginal COVID-19 vaccination milestone reached, but a gap remains – a message to General Practice Nurses

Thanks to the work undertaken by health professionals and Aboriginal communities across the state, in mid-September NSW reached the milestone of half of all eligible Aboriginal people the first dose of a COVID-19 vaccine.

All Aboriginal people age 12 and older are eligible and are a priority for COVID-19 vaccination, yet vaccination rates in this population are below the non-Aboriginal population, in some areas by up to 30% (first dose coverage, Source: Australia Immunisation Register, 30 September 2021). With the easing of restrictions in NSW fast approaching, it’s important to ensure Aboriginal people aren’t left behind when aiming for double-dose vaccination targets.

Priority vaccination for Aboriginal people is still important because of the increased risk of acquiring and developing serious illness from COVID-19.

Everyone within General Practice continues to play an important role in ensuring Aboriginal people have priority access to a COVID-19 vaccine.

NSW Health asked GPs, Practice Nurses and Practice Managers to share strategies to increase vaccination rates amongst their Aboriginal patients. This is what they recommend:

Contact your Aboriginal patients and offer priority vaccination

Advertising your vaccine-provider status helps, but pro-actively contacting your Aboriginal patients for a vaccination appointment will have a bigger impact: a phone call for some, SMS for others.

Use the opportunity to encourage your Aboriginal patients to bring their whole family/household to get vaccinated, and consider including web links to patient vaccine information in SMS message, including Q&A’s and information flyers.

Consider setting aside dedicated vaccination appointments for Aboriginal people each week, and ensure they are a priority when creating waitlists or when filling cancellations.

Give people the opportunity to identify as Aboriginal by asking the question

When people enquire about or book in for COVID-19 vaccination, asking the Aboriginal status question enables you to prioritise Aboriginal patients for appointments.

Accurate Aboriginal identification allows you to provide quality clinical care and is an opportunity to register patients for the CTG PBS Co-payment program. Aboriginal identification is also key to accessing funding under the Practice Incentives Program Indigenous Health Incentive. All patients should be asked the standard identification status question, consistent with RACGP recommendations and Standards for General Practice.

Making your practice inclusive and welcoming for Aboriginal people encourages self-identification (for vaccination and visits for other reasons). These practical steps will help in providing culturally safe healthcare and this printable reminder will keep Aboriginal patient identification top of mind.

Initiate conversations about vaccination with Aboriginal patients when they attend for other reasons

Use practice software prompts and action lists to identify Aboriginal patients during consultations, and ask about vaccination.

Information to help you discuss vaccination with Aboriginal people is available here. Aboriginal Health Workers in local Aboriginal Community Controlled Health Services can also support conversations about vaccination.

Promote vaccination to Aboriginal patients inside your practice and through other patient communications

Take advantage of your patients’ focused attention and run videos on your waiting room TV screens. The NSW Health “Yarn-Up” series is popular, so use Episode 1, Episode 2 and Episode 3 on rotation.

Displaying posters designed for Aboriginal people and having patient brochures available helps, as does posting about vaccination on your website and social media. You can share posts from the NSW Health pages (Facebook, Twitter, Instagram and TikTok) or create your own using our social tiles and videos.

If you don’t offer the preferred vaccine, help Aboriginal patients find another provider

If you’re not providing COVID-19 vaccination, or don’t have the preferred vaccine available, refer your Aboriginal patient to a local Aboriginal Community Controlled Health Service, an Aboriginal-specific Local Health District service or a local pharmacy vaccine provider (this may involve helping your patient make an appointment).

Not all patients will be comfortable attending mass vaccination clinics, so finding a clinic that suits their needs is important. Being familiar with other vaccine providers in your area will help. More options are coming on-line each week.

Recent improvements mean it’s now easier for patients to find a clinic, register and book an appointment via the Vaccination Clinic Finder. This requires internet access, so offering help to access the portal will assist.

If transport is an issue for your Aboriginal patients, consider offering in-home visits

Earlier this year, the Australian Government implemented MBS new funding arrangements to improve the viability of administering of COVID-19 vaccines via in-home settings. The new MBS item number (90005), when combined with an assessment to determine a patient’s suitability and administering the dose itself, makes a home-visit delivery model more feasible.

Additional information/support

And finally, if you have questions or would like additional resources to support Aboriginal people around COVID-19 vaccination, get in touch with NSW Health.

Thank you for the immense contribution General Practice is making to COVID-19 control and prevention efforts.

 

 

 

Nurses and midwives plead caution ahead of NSW reopening

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Nurses and midwives have described being ‘on tenterhooks’ about staffing shortages in Northern NSW public hospitals, while the state focuses on reopening after 15 weeks in lockdown.

NSW Nurses and Midwives’ Association (NSWNMA) members have urged local communities to exercise caution from next Monday, worried any spike in COVID-19 hospitalisations could overwhelm the health system and its already stretched nursing workforce.

​​​​​NSWNMA General Secretary, Brett Holmes, said widespread staff shortages were compounded by pandemic fatigue, particularly in regional areas like Northern NSW, where over 160 full-time equivalent (FTE) vacancies have been reported across the Local Health District.

“Prior to the pandemic, many public hospitals were struggling with staff shortages and relying on nurses and midwives’ goodwill to accept regular overtime requests to keep their services open,” said Mr Holmes.

“Unfortunately, that reliance hasn’t dissipated and now we’re hearing there are currently 163 FTE nursing vacancies in Northern NSW, with most in critical care, emergency, or medical and surgical departments.

“Our members at Lismore, Tweed, Grafton and the surrounding regions are all anxious about what lies ahead, given they have a very limited casual or agency pool to draw from. This is taking a toll on the remaining nursing staff, who often feel compelled to keep accepting overtime requests.

“Text messages are being sent to nurses daily, begging them to start early or work double shifts, to address the shortfall. This is not sustainable, especially when nurses and midwives can access safer workloads, as well as better pay and conditions, over the border in Queensland.

“There’s still a large portion of experienced nurses working in vaccination hubs and testing clinics, while our local hospitals grapple with understaffing and a junior workforce seeking support and clinical guidance.

“As the community looks forward to reintroducing some normality into their lives from next week, nurses and midwives don’t get to share in that luxury. They’ve had very little reprieve since the pandemic hit our shores some 22 months ago, and it’s far from over.”

The NSWNMA has encouraged Northern NSW Local Health District to explore all recruitment options to fill the current vacancies and urged other regional health districts to follow suit.

“This situation also isn’t isolated to Northern NSW. Our members in many other regional hospitals are struggling with understaffing,” added Shaye Candish, NSWNMA Assistant General Secretary.

“We’re aware Port Macquarie Base Hospital has had over 70 FTE vacancies recently, Maitland Hospital has more than 30, while Wagga Wagga Hospital is grappling with 64 FTE vacancies.

“These shortages put enormous strain on the remaining workforce, not to mention the additional stresses of the pandemic we’re still navigating our way through,” she said.

The NSWNMA called on the NSW Government to prioritise the health and wellbeing of all nurses and midwives by introducing nurse-to-patient ratios on every shift, in every ward across the state.

“Our members have done the hard yards in extremely tough circumstances and there’s still a way to go, but the best way forward is to deliver statewide nurse-to-patient ratios,” Mr Holmes said.

“The NSW Government must listen to nurses and midwives on the frontline and not ignore the fact Queensland, Victoria and Canberra all have ratios. We need a better health system in NSW and to achieve that, you need more staff.”