Janet Broady, Midwife and Parent Educator presented at the recent Midwifery Forum at the NSWNMA. Here she talks about her involvement with Antenatal classes for LGBTIQIQ parents.
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The Shift Ep. 90: Work, Health & Safety in the Workplace – Veronica Black
Veronica Black (WHS Professional Officer at the NSWNMA) spoke at the recent Mental Health and Drug & Alcohol Nurses’ Forum on Work, Health and Safety in the Workplace.
Q&A Drug Reform Special
The Q&A Drug Reform Special is live from ABC Sydney studios on Feb 18 with a panel of experts & advocates from both sides of the debate. Join our live studio audience by registering here https://ab.co/2HE72cJ & write NNMA in the ‘how did you hear about us’ box.
Q&A will also be taking Skype questions from around the country, submit your question here: https://ab.co/2OfVDC0
Got any questions you’d like us to ask? Put them in the comments!
Asylum seekers must be allowed medical treatment in Australia
The country’s largest union, the Australian Nursing and Midwifery Federation (ANMF) is calling on Federal MPs to support an amendment to the Home Affairs Legislation Amendment (Miscellaneous Measures) Bill 2018, in relation to the transfer of asylum-seekers from offshore detention centres for urgent medical treatment.
The amendment to the Bill, moved by Independent Senator Tim Storer and the Australian Greens, was passed by the Senate on 6 December last year.
ANMF Federal Secretary Annie Butler said politicians must listen to the ongoing concerns from the ANMF, the Australian Medical Association (AMA) and Independent MP Dr Kerryn Phelps, about the rights and needs of asylum-seekers to be allowed medical treatment on the mainland when they urgently need it.
“Nurses and midwives believe that our current offshore detention policies are morally reprehensible,” Ms Butler said.
“As a civilised, decent society, we must allow asylum seekers with serious medical issues to be transferred to the Australian mainland for the temporary purpose of assessment and treatment.
“Health professionals understand that there is simply no way of them getting the level of medical treatment they need in detention centres like Nauru.”
The ANMF supports any amendments which aim to have medical professionals overseeing transfers of asylum seekers rejected by the Immigration Minister and time limits placed on urgent medical transfers.
The Bill is expected to come before the House of Representatives on Tuesday, 12 February 2019.
Nine weeks in – a newbie ICU nurse’s story
A new nurse tells her story of beginning work in intensive care.
It’s been nine weeks since I first landed at the Intensive Care Unit (ICU) at Nepean Hospital.
I remember feeling very scared in the beginning. I felt I had been taken out of my comfort zone. I have been an EEN for three years but have mainly worked in the wards.
I spent my first 4 months as a new graduate in Endoscopy, so ICU is definitely a whole new unknown world for me. The orientation helped a lot, plus the one week I am supernumerary – I worked with a nurse buddy for the whole shift. My buddy showed me the basic stuff and the routine.
Now, after nine weeks working in ICU, I am ready to give you an idea of what a day in the life of an ICU nurse is like…
At the start of each shift we get the complete handover at the nurses station, then a bedside handover of the patient (ventilated)/patients (non-ventilated/cleared for ward) we are allocated for the day.
I start by doing a complete physical assessment on my patient. I also check my equipment and set my alarms. I check what drips are running and label each line, especially if the patient has central line with chooks foot extension.
Then I update my ICU flowchart, follow doctors’ orders for the day, administer medications due.
When it’s quieter, I focus on patient care. I give them a wash or shower, whichever is applicable. Oral, eye and pressure area care is very important, especially with patients on ventilator support.
We always put them on special mattresses and sequentials to assist with circulation. We encourage relatives to visit as this assists the patient’s recovery.
Most ICU patients feel isolated and helpless, they lose their confidence and interests. Lack of sleep is also a big problem due to the noise of alarms and the bright lights and constant prodding by nurses, doctors and physios.
I can relate to this so whenever I can, I give my patients time to rest and sleep by reducing the background noise and turning down the lights. The last thing I do before leaving the patients is make sure that they have enough pain relief if they need it.
The last part of my shift is spent documenting everything I did for the day. Then I know I’m ready to hand over my patient to next nurse.
Want to improve care in nursing homes? Mandate minimum staffing levels
The Royal Commission into aged care has begun its 18-month investigation into the quality and safety of Australia’s residential aged-care system.
Topping the list of priorities is to uncover substandard care, mistreatment and abuse, and to identify the system failures and actions that should be taken in response.
But we don’t need a royal commission to tell us the number-one thing that can improve care in nursing homes: implementing minimum staffing levels.
Based on our research from 2016, the Australian Nursing and Midwifery Federation recommends residents receive 4 hours and 18 minutes of care per day for optimal health and well-being.
It’s also important to get the right mix of staff performing for these hours and minutes. Half of the care should be provided by care workers (who undertake a short TAFE course), 30% by registered nurses (who complete a three-year bachelor degree at university), and 20% by enrolled nurses (who complete an 18-month diploma).
Nurse ratios in hospitals
It’s no surprise nurse shortages affect patient care. Nurse staffing shortfalls in hospitals have been associated with poorer patient outcomes, longer stays in hospital, and a higher risk of death within 30 days of discharge.
Poor staffing causes stress and frustration among nurses, who constantly feel rushed and unable to provide the type of care their patients deserve. This leads to greater job dissatisfaction and burnout.
One way to ensure nurse staffing levels is to implement mandatory nurse-to-patient ratios. California did this in 1999, when it mandated ratios ranging from one nurse to two patients in intensive care, to one nurse to six patients for women who had given birth.
After the ratios were implemented, the nurses’ patient loads decreased and they reported being able to provide better quality care. They also felt more job satisfaction and were less likely to burn out. Importantly, rates of complications and premature death decreased.
Minimum aged-care staffing
Seemingly small tasks in aged care can have a big impact on residents. If they don’t receive adequate assistance at meal times, for instance, they may lose weight and become malnourished. If they’re bed-bound and aren’t moved frequently enough, they’re at risk of developing painful pressure sores.
As with hospital-based care, minimum staffing ensures staff have enough time to complete these important tasks and has been associated with improvements in health outcomes for residents with multiple illnesses.
Importantly, increasing direct care hours reduces the use of medication to manage difficult resident behaviour, allowing residents to maintain their independence.
Increasing direct nursing care also decreases the likelihood of residents being transferred to emergency departments, as their symptoms can be managed in the facility.
One key downside, however, is that the introduction of minimum staffing levels can result in a shift away from employment of registered nurses towards staff with less education and skills, as has happened in the United States.
What happens in Australia?
All Australian states and territories have legislation to determine the minimum staffing levels in hospitals to ensure patients receive timely care and close monitoring. But no such legislation exists in the aged-care sector.
The current Australian Aged Care Quality Agency standards say aged-care facilities need to be adequately staffed with appropriately skilled and qualified staff but they don’t specify what constitutes adequate.
In 2015, residents in Australian aged-care facilities received 39.8 hours of direct care per fortnight. This averaged 2.86 hours per resident per day and is significantly below the recommended 4 hours 18 minutes per day.
Our research, commissioned by the Australian Nursing and Midwifery Federation commissioned research, set out to investigate what constitutes safe levels of staffing in residential aged care.
In phase one, we tested six “profiles” for residents requiring between 2.5 and 5 hours of nursing care daily, using the de-identified data of 200 residents. We then recruited experienced registered nurses to time and record what amounted to nearly 2,000 nursing and personal care interactions in hospitals, aged care and rehabilitation facilities.
We ran the six “profiles” made up of timed care activities through seven focus groups of nurses working in aged care to determine the proportion of residents who meet each profile.
Overall, we found more than 60% of aged care residents required four or more hours of care per day. This rate is likely to be similar in most aged-care facilities across the country.
The second component of our research involved surveying 3,206 staff working in aged care to determine the amount and types of care missed and the reasons why. This is care missed or delayed because of multiple demands, inadequate staffing and material resources, or communication breakdowns.
Staff believed care was being missed in all facilities, with higher levels of missed care reported in privately owned facilities (both for-profit and not-for-profit).
Unscheduled tasks such as responding to call bells and to toileting needs within five minutes were most likely to be missed – as were the social and behavioural needs of residents.
Complex care activities such as wound care, medication and end-of-life care were less likely to be missed, although there were deficits in some areas.
When asked to indicate the reasons why care was missed, the respondents cited:
- having too few staff
- the complexity of resident needs (for example, more residents receiving palliative care and with dementia)
- inadequate skill mix of nursing and care work staff
- unbalanced resident allocation (some staff having heavier workloads than others).
Beware cost saving
Many of the problems in the aged-care sector can be addressed with adequate staffing, and ensuring residents receive, at a minimum, the required 4 hours and 18 minutes of care each day. But staffing hours should not be increased by replacing nursing staff (who have clinical education and skills) with lower-skilled care workers.
In recent years, some residential aged-care providers have been reducing the number of enrolled nurses employed and substituting them with care workers to offset staffing costs. Between 2003 and 2012, 21,000 more care workers were employed, along with 2,326 fewer registered nurses.
It’s important to ensure the skill mix includes enough registered nurses for the complex assessment and specialised nursing care now required by residents.
It’s clear the royal commission must investigate staffing shortfalls rather than simply blame nurses and carers who often struggle to provide the level of care they’d like to.
This article was written by Julie Henderson, Research Associate, Southgate Institute for Health, Society and Equity, Flinders University and Eileen Willis, Emeritus Professor Eileen Willis, Flinders University
This article is republished from The Conversation under a Creative Commons license. Read the original article.