August 12, 2022

Workplace Issues

Nurses and midwives’ fight for ratios rolls on

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Hundreds of nurses and midwives have called on the NSW government to take responsibility for the understaffing crisis currently hampering the public health system and voted to continue the fight for nurse-to-patient ratios.

During the NSW Nurses and Midwives’ Association (NSWNMA) 77th Annual Conference in Sydney, delegates and members described the widespread risks and chaos nurses and midwives are working under every hour of every shift.

A resolution moved by NSWNMA Tamworth Base Hospital Branch called on Health Minister and Regional Health Minister to urgently visit rural and regional health facilities and speak with clinicians to discuss staffing and workload issues supported by their union, without hospital executives.

NSWNMA General Secretary, Shaye Candish, said there was a high level of disconnect between the dire situation across the health system and the NSW government’s perceptions, given the reluctance to address ongoing concerns.

“Overtime and working short is becoming normalised. This is not safe staffing and the growing evidence of burnout and fatigue among nurses and midwives is beyond alarming,” said Ms Candish.

“Our members are fed up with being ignored by the NSW government and they are desperate for change. They have been put through enormous moral injury and are done being overworked.”

A reoccurring theme across the conference was a genuine commitment to continue speaking up and to pursue safe staffing on every shift, in every ward, at every hospital.

NSWNMA Assistant General Secretary, Michael Whaites, said it was imperative the NSW government started listening to the calls of the highly skilled clinicians and their professional input.

“Right across the state, members have indicated that not enough is being done to address serious safe staffing concerns and they are determined to be heard,” said Mr Whaites.

“Nurses and midwives, regardless of their specialty area, have been advocating to improve patient safety at every turn. It is mind blowing that the NSW government is not heeding the warnings of our members – they are ones living and breathing the crisis across our health system.

“It is unconscionable clinical professionals’ voices are not being heard.”

NSWNMA delegates and members indicated they would continue raising public awareness on the benefits of introducing nursing and midwifery ratios to improve patient safety and the future sustainability of the workforce.

New leadership at the helm of NSWNMA

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The NSW Nurses and Midwives’ Association (NSWNMA) has announced General Secretary, Brett Holmes, will conclude his leadership at the end of this week after two decades in the top job.

Mr Holmes, who was elected General Secretary in August 2002, formally announced his retirement to delegates and members during the NSWNMA’s 77th Annual Conference in Sydney this morning.

“After careful consideration, I decided now is the appropriate time to conclude my roles as General Secretary, and Branch Secretary of the Australian Nursing and Midwifery Federation NSW Branch, and to make way for new leadership of our union,” Mr Holmes said.

“I am honoured to have served the Association and its members for the past 32 years in my roles as an Organiser, Organiser Team Manager, Assistant General Secretary, and then as General Secretary for the last 20 years.

“I have returned that privilege by working as hard as I possibly can each day with the interests of our membership, both at work and in the communities in which they live and care for, as my driving purpose.

“It has been very humbling and rewarding. However, I believe it is a good time to extend our membership a chance for renewal and allow our two exceptionally talented new leaders the opportunity to map the union’s best path forward.”

Mr Holmes first trained as a registered nurse in Sydney in 1980, then as a psychiatric nurse for several years before becoming a midwife. He transitioned from clinical practitioner to trade union organiser when he started work at the NSWNMA in 1990.

Mr Holmes was elected as Assistant Secretary of the union in 1999. He was elected by the Council in August 2002 as General Secretary and subsequently elected by members in 2003, and then re-elected unopposed in 2007, 2011, 2015 and 2018.

Regarded as measured and approachable by his peers, Mr Holmes has dedicated his career to fighting for improved pay, conditions and workers’ rights, as well as acknowledgement of the nursing and midwifery professions in NSW, nationally and around the globe. The NSWNMA’s membership has grown from 48,000 to almost 75,000 under his leadership.

Mr Holmes is a director on the board of superannuation fund, HESTA. For many years, he has also sat on the ACTU Executive, Unions NSW Executive, ANMF Federal Executive and Council, the NSWNMA Council, chaired the Edith Cavell Trust, and a director of legal firm, New Law.

Today Mr Holmes also announced the NSWNMA Council had appointed current Assistant General Secretary, Shaye Candish, as his successor and the Director of Strategy and Transformation, Michael Whaites, was appointed as the new Assistant General Secretary.

“Shaye and Michael are a dynamic team. Together, they’ll continue pursuing improved outcomes for all nurses and midwives, as well as persisting in our campaign for safe nurse-to-patient ratios across all sectors,” said Mr Holmes.

“Shaye’s genuine advocacy for nursing and midwifery, and the broader union movement, are reflected in her strong leadership qualities.

“Michael has been a dedicated advocate and strategic campaigner for our members over many years, as well as for the betterment of nurses and midwives globally.

“I congratulate Shaye and Michael wholeheartedly on their appointments and look forward to them confidently leading our union at the forefront of the movement.”

Nurses and midwives remain determined to speak out

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A resolute crowd of nurses and midwives from the health and aged care sectors have gathered to share their experiences and support each other to speak up on the widespread issues hampering their professions.

During day one of the 77th Annual Conference of the NSW Nurses and Midwives’ Association (NSWNMA) in Sydney and online, participants reflected on workplace struggles and the ongoing pandemic.

Nursing leaders and academics from Scotland, Canada, the United States and Australia shared their insights into the supply demands on nurses and midwives, and a lack of preparedness to ensure health systems are adequately resourced.

Professor James Buchan from the University of Edinburgh explored research showcasing the global need for a better nursing and midwifery future.

“One of the underlying major concerns is that many systems are putting a lot of emphasis on individual nurse resilience to somehow continue to get through this and the reality is the emphasis should not be on the nurse to be resilient, it should be on the system to support the nurse,” said Professor Buchan.

President of the Canadian Federation of Nurses Unions, Linda Silas, shared the common struggles to secure safe staffing and nurse-to-patient ratios.

“One in two nurses is saying ‘Bye bye, I’m looking for the exit sign, I want to leave.’ And we know that one in five healthcare workers, so that’s the whole healthcare workforce are looking to retire early and we need to change that very quickly,” said Ms Silas.

Bonnie Castillo, Executive Director of National Nurses United in the United States highlighted the enormous drain on clinical practitioners because of cracks exposed in the health system.

“Healthcare workers are done. They are done being applauded as essential while being treated as expendable,” Ms Castillo said.

Assistant General Secretary of the NSWNMA, Shaye Candish, spoke about the undervaluing of input from highly skilled professionals when health policies are developed and decided.

“The overwhelming pressures on nurses and midwives has never been more unrelenting. The uphill battle to have our voices heard remains, as does the need for your clinical insights and experiences to be afforded a seat at the decision making or policy drafting table,” said Ms Candish.

While Professor Joseph Ibrahim from Monash University summarised the extraordinary plight of nurses in Australia’s aged care sector and the lack of input sought from clinical professionals.

Professor Ibrahim reflected, “There were no nurses involved in the pandemic planning for aged care. There were no nurses actually working in aged care that are represented on any of those groups that were making the decisions.”

NSW falls behind other states in pay and respect

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The Queensland Government’s pay offer to the state’s nurses and midwives makes a mockery of the NSW Premier’s claim that his deal is the highest in the land.

 First, there was a decade of wage caps at 2.5 per cent. Then a contemptuous 0.3 per cent pay rise for public sector nurses and midwives in the first year of the COVID pandemic. In the following year, 2021, there was a 1.5 per cent increase.

Yet, Premier Dominic Perrottet has the audacity to publicly say NSW is the best paying state.

This year the Perrottet government has raised its wage cap to 3 per cent and up to 3.5 per cent in 2023–24  – but only if there are productivity offsets.

NSW will also make a one-off $3000 payment to permanent NSW Health workers “to recognise their work on the frontline of the COVID-19 epidemic”.

Queensland, by contrast, has rewarded its nurses and midwives for their stellar efforts during COVID with an offer of an 11 per cent pay rise over three years plus a top-up cost-of-living payment of up to 3 per cent a year.

They will receive 4 per cent in the first year of the agreement, 4 per cent for the second year and 3 per cent for the third year.

The cost-of-living top-up payment would be a lump sum equal to the difference between the inflation rate and the base wage increase for that year, up to a maximum of 3 per cent.

For example, if inflation increases to 7 per cent – as has been predicted by the Reserve Bank – they would receive a 4 per cent increase plus a further 3 per cent as a lump sum in order to keep their wages in line with inflation.

The Queensland offer also has an increase in Sunday penalty rates from 175 per cent to double time and paid Pandemic Leave of up to 20 days (before the use of personal/sick leave) for COVID-positive nurses, among other gains.

Both Premier Perrottet and his deputy Paul O’Toole have claimed that Victorian nurses have only been offered 1.5 per cent “and they’re not going out on strike”.

In fact, Victorian nurses aren’t even in a bargaining period at this moment and have already negotiated a 3 per cent increase they will receive in December. They also got 3 per cent last December and 3 per cent the December before.

That compares with the 2.5 per cent, 0.5 per cent, and 1.5 per cent wage rises “granted” by the NSW Government over the last three years.

NSWNMA Assistant General Secretary Shaye Candish says NSW is falling further and further behind other states, which have implemented ratios and have rewarded their nurses and midwives with higher pay.

“The wage rises and ‘cost-of-living payment’ on offer to Queensland public sector nurses and midwives is reflective of a state government that respects and values their nurses and midwives,” she said.

“We know NSW nurses and midwives have already moved to work in Queensland and Victoria, where they have safer staffing levels in their public hospitals as a result of mandated nurse-to-patient ratios.

“Now we’re concerned more will follow, as their wages continue to go backwards under a broken wages system.”

What Queensland nurses and midwives have been offered

  • A four per cent increase in the first year of their agreement, four per cent for the second year and three per cent for the third year.
  • Plus a cost-of-living top-up payment that would be a lump sum equal to the difference between the inflation rate and the base wage increase for that year, up to a maximum of three per cent.
  • Queensland has already impl-emented shift-by-shift ratios.

National minimum wage goes up 5.2 per cent

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The Fair Work Commission has ruled that minimum wage earners will get a $40 a week pay rise, a decision that was supported in advance by the Albanese government.

The decision will see the hourly pay rate rise from $20.33 to $21.38. The decision impacts 2.7 million workers on the national minimum wage or awards and came into effect on 1 July.

ACTU Secretary Sally McManus welcomed the increase. She said the lack of wage growth has been and still was “a critical issue for our economy and we need concerted action to address it”.

“Our current system means that despite low unemployment, high productivity and record profits, labour’s share of GDP is at a record low,” she said.

“The (minimum wage) review is one tool we have to generate wage growth, but it only affects one in four workers – we need wage growth across the economy.”

Prime Minister Anthony Albanese agreed the pay rise would help prop up the economy.

“If you are on the minimum wage, you are also spending every dollar that you have. Every dollar that you receive will go back into the economy into circulation,” he said.

“It won’t go into savings, not an overseas holiday. It will go into food on the table, for kids of people on minimum wages. That is what this is all about.”

Ask Shaye: Special edition – Rural Health Workforce Incentive

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When it comes to your rights and entitlements at work, NSWNMA General Secretary Shaye Candish has the answers.

The lack of logic and public alarm is disturbing

Early August 2022, and we have COVID-19 and influenza cases reaching peak levels. Two and a half years of preparation, awareness and lived experience should have been enough to ensure readiness. But what has been delivered? Record numbers of COVID-19 cases, hospitalisations and, sadly, deaths. Influenza case numbers not seen for years. All-too-predictable levels of staff being absent – either unwell or in isolation, or simply crushed under the weight of work demands.

Our public health system lies near broken. Aged care facilities are being ravaged by outbreaks in numbers beyond even last year. We continue to break records, but all the wrong ones. And what is the response?

The usual political speak about a system being under pressure but coping. A fear to be honest and confront the reality of the situation – equal parts hubris and ignorance.

Have we learned nothing? Care cannot be delivered if nurses and midwives are not there, or staffing accountability on a shift-by-shift basis is not present. Regardless of the health or care setting, more nurses and midwives are needed. Governments of all persuasions and their bureaucracies need to admit we have reached rock bottom.

If we are open and honest about that fact, then maybe we can really start to rebuild.

Special edition –  Rural Health Workforce Incentive

Budget announcement

Where did this new scheme come from?

Leading up to the NSW Budget, the NSW Government announced it would commit $883 million over the next four years to attract and retain staff in rural and regional NSW. However, the release was big on headlines and light on detail.

Timing

Why now after all these years?

There is absolutely no doubt that the sustained pressure of Association members, and the damning findings of the Upper House Inquiry into health and hospital services in rural, regional and remote New South Wales, meant the NSW Government could no longer avoid this longstanding and endemic problem.

New Health policy

How will this scheme to be applied in the NSW Health Service?

The Ministry of Health recently released the Rural Health Workforce Incentive Scheme. This sets out the broad framework of the scheme, along with its key features.

Union input

Did the Association have any input to this new policy?

Whilst the Ministry of Health initially sought some feedback from public health unions on this initiative after the NSW Government’s announcement, unfortunately without further consultation or receiving answers to the many questions we posed, the Ministry released the policy directive.

Categorisation of the bush

Where will the incentive schemes be applied?

It will only apply to locations in NSW outside the metropolitan and regional city centres and their immediate surrounds. Rural and regional hospitals and services will be classified using the Commonwealth Department of Health’s Modified Monash Model, with the incentives potentially available to those identified as being MM3 to MM7. For example, Wagga Wagga would be classified as MM3, Mudgee MM4, Lockhart MM5, Nyngan MM6 and Bourke MM7.

Other locations may be deemed rural and remote by the Ministry of Health considering unique location attributes that present challenges to attraction and retention of the health workforce.

Positions included

What roles will potentially be included in any incentive?

Firstly, it will only apply to roles undertaken by employees of the NSW Health Service, and excludes contractors, agency nurses, Visiting Medical Officers or contingent workforce who are not paid through the NSW Health payroll.

Secondly, to have the incentives applied (recruitment or retention) to a specific position or class of role, they will need to be identified as being hard to fill or a critical vacancy as defined under the policy directive.

Incentives

What is the value of the incentives? 

The value of the incentive that could be applied to a position or a class of role will be either $5,000 or $10,000, depending on the MM rating and whether the position is hard to fill and / or critical to service delivery. Additional benefits over and above this amount can be considered in certain circumstances.

Monetary incentives

What type of things could the incentives be used for? 

Examples used in the policy directive (noting some are dependent on the MM rating applied) include: professional development; computer/internet reimbursement; additional personal leave; additional base salary; reimbursement of utilities; family travel assistance; transfer incentives (see below); study assistance; or a cash bonus.

Transfer incentives

What are the transfer incentives mentioned?

This includes a right to return to your substantive position (or like position) if only undertaking a fixed temporary secondment. However, it does also include consideration of a priority transfer to a preferred location nominated by the worker at the conclusion of the secondment. This would need to be agreed prior to commencing the incentivised engagement and have Ministry of Health approval.

Package makeup

Who decides the makeup of any incentive package?

A range of options may be used to tailor the recruitment or retention package that suits the individual ie it is not necessarily intended to be a one size fits all approach (as understood by the Association). You should have a say in how you would like the incentive used.

Leaving the scheme

Can I leave an incentivised placement early?

Certain constraints are applied if one was to leave an incentivised position prior to its term concluding, with repayment requirements possible. However, it may be possible to transfer to another incentivised role and maintain the incentives in place.

Next steps

What happens next?

Members should check out the policy directive whilst the Association seeks to have the many unanswered questions clarified by the Ministry.