February 25, 2021

Workplace News

Blacktown goes after safer staffing

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Taking action has helped midwives and nurses secure a promised staffing increase for Blacktown Hospital’s maternity service.

More than 150 midwives and nurses walked out during afternoon shift, after a vote by members of the NSWNMA’s Blacktown Hospital branch working in maternity services.

More than 80 per cent of members at the meeting voted to act.

They were joined by nurses from across the hospital who walked off the job in a show of support for their colleagues, who were advocating for safe patient care.

Members ensured enough staff stayed at work to keep affected units open and functioning.

The vote followed the deaths of five newborns at the hospital over the previous 18 months.

The number of babies delivered has increased rapidly over recent years, with an average of 11.5 births every 24 hours.

About 20 obstetricians had threatened to resign over unsafe staffing shortly before the midwives and nurses took action.

NSWNMA General Secretary Brett Holmes said management had failed to act decisively to improve patient safety.

Midwives had been “understandably traumatised by tragic deaths and believe the staffing issue has become untenable, putting their registration at risk,” he said.

Management of Western Sydney Local Health District (WSLHD) immediately took the dispute to the NSW Industrial Relations Commission (IRC), which, as expected, ordered staff to go back 
to work.

The IRC also ordered that no action be taken by any NSWNMA member working in  the NSW public health system for three months.

But the action gained wide media attention for the midwives’ safety concerns and got the issue into the IRC, where management had to commit to resolve the midwife shortage.

As a result, the hospital has started advertising for an additional 15 full-time-equivalent midwives, an after-hours clinical midwifery educator and backfilled the vacant skin-to-skin midwife position.

Data collection for Birthrate Plus – the tool NSW Health uses to determine maternity staffing 
levels – is also underway and is expected to be completed in February/March 2021.

Management agreed to expedite the Birthrate Plus review by six months, after members highlighted the 30 per cent increase in birth numbers at Blacktown Hospital.

Midwives hope this will lead to further midwifery positions being created.

Brett said the commitments achieved were “a great outcome” for all nurses and midwives at 
Blacktown Hospital.

He said it came as a result of branch members taking action, attending meetings and rallies, speaking to media and giving evidence at the IRC.

“More needs to be done to ensure improvements across the service and hospital and together we can do this,” he said.

NSWNMA members still had to apply further pressure to hold management to its commitment to increase the number of midwives by 15 FTE positions.

They rallied in their own time outside Blacktown Hospital to demand that WSLHD advertise the positions without delay and act on other staffing issues, rather than referring them to a sub-committee for further delay.

The NSWNMA then filed a dispute in the IRC, which caused management to advertise the new positions just hours before the IRC hearing began.

Talks over maternity services continued at the hospital’s Reasonable Workload Committee in January.  NSWNMA reps said there was a more open discussion and “management were willing to discuss items that were previously off the table.”

Hospital-wide support for maternity staff

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Members across all services strongly supported the stand taken by Blacktown maternity unit staff.

Blacktown Hospital branch president Katie Conciatore said the deaths of newborns had affected all parts of the hospital.

“Obviously, dealing with death in a hospital is a part of the job,” she said.

“However, when it’s in an area that doesn’t see death often, you wouldn’t find many unaffected by that and looking to do something to improve the situation.

“People are happy to support each other because we have been having these same fights over staffing across different departments for years and got nowhere.

“Everyone is over being short-staffed and under-resourced.

“The infant deaths just capped it off – particularly because staff in maternity services have been warning management about this for years.

Many nurses from areas such as theatres, emergency, surgical and aged care attended the 
branch meeting and supported us, Katie said.

“After the vote, in the time it took me to walk over to the hospital executive to hand them the resolution and notice that we were walking, the crowd of nurses and midwives in Hospital Street was probably double the number I expected,” she said.

“Some of them came with signs such as ‘Aged Care Nurses Support Midwives’.

“They didn’t stand to immediately benefit from showing solidarity. Everyone was saying, it’s the midwives now but we are next.”

Stewards’ vital role

Blacktown branch laid the groundwork for cross-hospital solidarity by building a network of stewards in all services.

The branch has 20 stewards across the hospital, including a number in maternity services at the time of the action.

“Each time we have issues affecting a particular service – ICU, ED, surgical ward, aged care ward – we can alert stewards across the hospital,” Katie said.

“They can quickly share info to members and go around their units to talk to people.

“This allows us to get people to a meeting quickly. The meeting was called in the morning and held with a huge attendance in the afternoon.”

Walkout sends a strong message

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Blacktown Hospital midwives take strong action to protect the health and safety of mothers and babies in their care.

NSWNMA branch steward Rachel O’Donnell said members discussed the pros and cons of action before the NSWNMA branch meeting vote.

“How would we go about it? And how would it benefit us?

“Once we understood how it would work, and how we could ensure it would not leave the wards without any staff, people were worked up enough to support it,” Rachel said.

“There wasn’t a lot of trust in management because we had been trying to work with them to solve staffing issues for at least 18 months. They had made a lot of empty promises and none of us wanted it to drag on any longer.”

Representatives of midwives and the branch met with Western Sydney Local Health District management on the morning of the action.

Management offered to employ another 15 midwives but would not commit to a time frame. The LHD also wanted to send all other issues off to a committee of managers and midwives for more discussion.

The branch called a meeting where “the feeling was that we had to send a clear message that we were ready to stand together to fight for what was right for patients and staff.”

“We wanted to keep the issue in the spotlight so management couldn’t keep delaying things.”

The walkout covered the birthing unit and maternity ward along with members from outside the maternity service such as theatres and general medical wards.

“We did a lot of work to spread the word and gain support throughout the hospital,” Rachel said.

“We already had a lot of support from theatres because we work closely with them. Our branch officials were always really supportive; they sent messages to other wards and got positive feedback from them.

Union reps on the wards looked at the day sheets and worked out the numbers who needed to stay behind during the action.

An overwhelming vote in favour of action

The vote took place at the end of morning shift and was overwhelmingly in favour. The afternoon staff walked out as a group and gathered outside the hospital for a short, lively meeting. “It was a very positive atmosphere,” Rachel said.

She and others expected to be ordered back to work by the Industrial Relations Commission.

“But when the order finally came, it was a blow to some of the midwives and created some uncertainty. Some of them were asking, does this mean we’ve lost?

“However, most knew they had sent a strong and unified message to management. I think it was cathartic for the midwives to stand up and tell management they had had enough.”

Rachel says the dispute has strengthened ties between midwives and their union, the NSWNMA.

“Before this dispute we knew the union was there but didn’t really know how we could engage with them or how exactly they could help us,” she said.

“Now there is a more positive feeling that the union can help us when we’re really stuck.

“A lot of the staff see the union as more accessible and realise together we are the union.

“The people from the union office were great. They were there for us when we needed them and they let us make our own decisions.

“They helped us advocate for the staffing levels we know mums and babies need. Without their guidance and support we definitely wouldn’t have got anything like we did.

“There’s still a lot of work to do but this whole process will help to improve the care we can provide to mothers and babies and that was always our goal.

Rachel said the new, modern maternity wing was welcomed by all and it was a relief to now see new positions finally being advertised that were needed to staff it properly.

“The birthing unit is quite excited about the prospect of getting an after-hours clinical midwifery educator. It will help relieve the pressure on midwives in terms of educating students and provide better support for students.

“It is also important to have achieved an agreement that the Midwifery Unit Manager 1 will not be expected to perform MUM 3 duties while she is on leave because we can now have the NUM 1 working effectively.”

Staffing lags behind births

Since 2015, births at Blacktown Hospital have increased 52 per cent, while staffing has only risen 11 per cent.

Blacktown was averaging11.5 births every 24 hours last November, with often only seven midwives rostered per shift. Meanwhile, at Westmead Hospital, midwives were assisting with an average 13.7 births in 24 hours, with 10 midwives rostered per shift. Blacktown midwives were  being rostered for multiple  day and night shifts of up to  64 hours over seven days despite 56 hours being the maximum allowed.

Healthscope gets thumbs down

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Nurses and midwives vote for improved staffing by rejecting Healthscope’s enterprise agreement.

Healthscope nurses have voted to reject a company proposal for a new enterprise agreement that offered no solution to widespread understaffing of its hospitals.

Healthscope arranged the secret ballot in December. It was run by an independent organisation called Elections Australia.

Healthscope did not disclose the voting numbers but feedback from NSWNMA members suggests the ’No’ vote advocated by the union achieved a comfortable majority.

Owned by Brookfield, a Canadian company, Healthscope operates 12 hospitals and clinics in NSW.

The current enterprise agreement expired in February 2020 and a pay increase was due in July 2020.

Bargaining between Healthscope and NSWNMA representatives started in September, after a long delay due to COVID-19.

Healthscope initially offered a 1 per cent pay increase from October, and 1 per cent from October 2021, with no other major improvements.

A slightly improved offer that went to the vote included back pay of 1 per cent from July 2020 and 1 per cent from July 2021, plus a 10-hour break after overtime but not between shifts.

Healthscope refuse staffing improvements

NSWNMA Acting General Secretary, Judith Kiejda, said members in all Healthscope facilities were looking for staffing improvements, which the company failed to offer.

She said the NSWNMA decided its position after consulting with members every step of the way.

“Members told us they were sick of not having enough staff rostered on to take meal breaks and needed a 10-hour break between shifts and after overtime,” she said.

“Members said their priorities were staffing improvements, a fair wage increase and protection of existing conditions for Northern Beaches ‘migrating employees’.”

Bargaining reached an impasse when Healthscope refused to consider the NSWNMA’s safe staffing claims.

There were no improvements to staffing, no solution to missed meal and tea breaks, and no 10-hour break between shifts.

Healthscope’s “final” offer also included less leave for part-time shift workers than the legal minimum.

For “migrating employees”, Healthscope’s offer slashed their conditions by removing nursing-hours-per-patient-day ratios and eliminating 10-hour breaks between shifts.

There were cuts to parental and other forms of leave, removal of accrued days off and cuts to redundancy pay.

Staff took dim view of offer

Staff generally took a dim view of Healthscope’s enterprise agreement offer, said Rohini Kiran, a member of the NSWNMA’s Healthscope EA leadership team.

“Some said it was a joke, others called it an insult, so I wasn’t surprised by the ‘No’ vote,” Rohini said.

“With all the work we do, what is a 1 per cent pay rise with no staff-ing improvements?”

She said, “On a positive note, I love working for Healthscope” but added that inadequate staffing is the biggest concern among nurses.

“In my case, I work night shift with a 12-patient load alongside an RN or EN, also with 12 patients.

“Also, I am sometimes ‘hospital in charge’, with overall responsibility for about 100 patients.

“If something happens on another ward, I have to leave my colleague on their own to attend to the problem. That’s a potentially dangerous situation.

“Some wards do not have an AiN on night shift to help with heavy patients.

“When the patient load goes down to 23 on the ward, they start cutting staff. They look at numbers, not the acuity of patients.”

She said excessive workloads often cause staff to miss out on breaks.

Rohini said insufficient breaks between shifts is “a huge issue”.

“Before I started night shift, I worked evenings and sometimes I’d be asked to stay back and work a night shift. By the time 7.30 am comes around, your feet are burning. And then they’d still expect you to come in at 4 pm.

“If you are tired and exhausted and make a mistake, who does it fall on? I wonder if management will take the blame. It’s the nurse who will lose their registration.”

More nurses are a priority

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Theatre nurses at Newcastle Private Hospital want improved staffing arrangements and a reasonable pay increase as priorities in the next enterprise agreement, said NSWNMA branch steward and theatre RN Sheoni Corrigan.

“We don’t have the number of staff we need to run our theatres efficiently,” Sheoni said. “We need to find a way to staff our theatres better, or not do so many operations.

“We need more nurses on shift and ‘like-for-like’ replacement of nurses on leave, to reduce excessive workloads. We need our meal breaks enforced.”

Sheoni said theatre staff believe an increase in parental leave – currently 10 weeks – is also important.

“Our staff are pretty much on the same page and generally disappointed that Healthscope didn’t offer anything that reflected our hard work and dedication.

“The overwhelming feeling was that the company offer was inadequate, and I believe that feeling is shared by other areas of the hospital, which are all short-staffed.”

Staff commitment goes unrewarded

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Northern Beaches Hospital nurses and midwives are united in seeking safer staffing ratios.

“Mandatory ratios would make everyone’s job safer and more manageable,” says Northern Beaches Hospital branch secretary Felicity Melville.

“Public nurses have had minimum staffing levels for years. That’s what all our people want, whether they are classified as migrating staff or work under a Healthscope agreement.

“We all want a safe working environment that allows us to give excellent care to patients.”

Northern Beaches staff include nurses and midwives who transferred from Mona Vale and Manly public hospitals.

Known as “migrating employees”, they are covered by an award copied from the Public Health Award.

This award generally provides better conditions than those applying to other Northern Beaches nurses who work under a Healthscope enterprise agreement.

Copied award conditions include minimum nursing hours per patient day, like-for-like replacement of staff and ACORN standards for operating theatres.

Migrating employees’ conditions under threat

Migrating employees also have 14 weeks parental leave (compared to 10 in the Healthscope agreement), a higher rate of long service leave accrual, and 10-hour breaks between shifts and after overtime.

The copied award applies for five years (from October 2018) unless Healthscope replaces it with another agreement, which it is now seeking to do.

Felicity, who came to Northern Beaches from Manly hospital, says staff in both categories have worked well together for two years and are united in seeking a better deal than Healthscope’s offer.

She points out that some of the migrating staff worked in public hospitals for up to 30 years.

“They committed to come across and build the new privately-operated hospital, which was a difficult process, especially in the first six months.

“We worked really hard to get the new hospital where it is, so we were disappointed to find out that Healthscope undervalued that contribution and wanted to take away conditions the migrating staff had had for a long time.

“The branch believes Healthscope should extend at least some of those conditions to all Northern Beaches nurses, who have worked together to create a fantastic environment to provide excellent patient care.”

Healthscope didn’t listen

In an email to all nurses, Healthscope said it was disappointed that staff rejected its offer.

Felicity says the email suggests Healthscope did not hear nurses’ concerns.

She was not surprised to see the Healthscope offer voted down after the company refused to give any concessions on members’ requests for improvements.

“In the emergency department, where I work, we had almost daily discussions about what we wanted to do about the company’s offer,” she says.

“We came to a consensus that it would be a ‘no’ vote and that position was very well supported throughout the wards.

“Offering only a 1 per cent increase in the Year of the Nurse and the year of COVID-19 was an insult. However, it wasn’t the main focus for either group of employees.

“There was a positive mood in our branch meetings because everyone was on the same page and we were all fighting for the same things, such as better staffing and non-wage entitlements that were either going to be taken away or not put in place.”