NSWNMA members, voting through their branches, have unanimously supported our Public Health System award claim.

The 2018 claim was put together after months of research and consultation with Public Health System (PHS) members. The vote on the claim was conducted between 19 March and 27 March. One hundred and seventy-eight branches in the public health system supported the claim. None were opposed.

NSWNMA Secretary Brett Holmes says the claim seeks to improve and extend ratios across NSW.

“Where ratios already exist in the system the claim proposes that they are applied shift-by-shift based on the number of patients in each ward, unit or service,” he says.

“This is a major change. Currently ratios are calculated based on patient numbers over a week.

“We are proposing a simpler and more accountable way of calculating the appropriate ratio.”

Meg Pendrick, branch President and delegate at Gosford Hospital, says the formula for calculating ratios needs to be much clearer.

“Everyone interprets nursing hours-to-patients differently; it is just too open for interpretation. That is not what we originally campaigned for, and a lot of us are scratching our heads,” she says.

“We are asking for more transparent and simple ratios. It would be nice to see it more consistent
and spread across all areas of nursing, and a more accurate interpretation.”

The 2018 claim does seek to introduce ratios into areas where they are currently lacking, including paediatric and neonatal intensive care units and in emergency departments, emergency medical units and medical assessment units.

It will also look to extend ratios to adult, paediatric and mental health intensive and critical care units, and to more mental health units.

There is also a claim to introduce a ratios-equivalent system in community and community mental health.

Brett says the union’s claim has been influenced strongly by international research and local experience in NSW, Victoria and Queensland.

“There are numerous large-scale, well-regarded international studies that show a direct correlation between safe nurse-to-patient ratios and improved patient outcomes.

“Those studies are clear: unsafe nurse-to-patient ratios increase the risk of dying.

“The studies prove that ratios save lives. In the face of this evidence we cannot remain silent. It is our professional responsibility to advocate for stronger ratios.”

Members have also voted for a 4 per cent increase in pay and wage-related allowances per year. The next pay increase is due in July this year.

Nurses and midwives deserve a fair pay rise

Brett says there are many compelling reasons why nurses and midwives in NSW should get a pay rise.

“Our members have increasingly been asked to do more with less. Yet, their increase in productivity has not been rewarded for many years.”

A legal restriction on public sector wage increases in NSW has affected nurses, midwives and other health workers.

The Liberal–National government imposed the cap in 2011 by overriding the Industrial Relations Commission’s powers and capping wages by law, at a maximum of 2.5 per cent per year unless trade offs are accepted in return.

A cap on nurses and midwives’ wages in Britain was recently scrapped after health unions and NHS employers argued it had damaged public health services.

NHS Confederation chief executive Niall Dickson said the organisation did not believe the pay cap was sustainable and NHS employers had a “mounting concern about both recruitment and retention of vital frontline staff”.

Brett says there are similar concerns about recruitment and retention in NSW.

“Many nurses and midwives are telling us they have ‘a leaving plan’ due to the unrelenting pressure and the difficulty in delivering the care they believe patients deserve.”

He says there are also broader economic reasons to support a pay rise.

“Organisations as diverse as the Reserve Bank, the International Monetary Fund and the ACTU are all saying that stagnant wages have put a brake on economic growth.

“There is no logical reason to maintain the pay cap in NSW. The state government should scrap it and negotiate in good faith with its nurses and midwives for a fair increase in their wages.”

 ‘I think we deserve to be better compensated’

In-charge nurses should be exempt from carrying a patient load in order to provide safer and better-quality care, says Lennie Murphy.

Lennie works in the haematology ward of a Sydney hospital and is an NSWNMA branch delegate.

“On our ward, the in-charge is one of the more senior nurses and usually looks after the more complex, unstable and unwell patients,” she says.

“It is very problematic to also have to carry out the responsibilities of the in-charge nurse, such as supporting and educating junior nurses, liaising with bed managers, and attending to other issues that arise on the ward.”

Lennie is also concerned at the use of agency nurses to replace RNs on specialised wards such as haematology.

“An agency RN with no haematology experience is not a like-for-like replacement for an RN who may have four or five years of experience in this field.

“Our in-charges are not only managing the ward and looking after their own patients, they also have to look after patients assigned to the replacement nurse who may not have the appropriate levels of skill and experience.

“The result is compromised care, increased burnout and lower staff morale.”

While the haematology ward does have ratios, they are based on the midnight census, which does not truly reflect actual ward activity, she says.

“We need to carry out the census at different times throughout time to capture the true activity on the ward.”

Though she works in a large Sydney hospital, Lennie says the union should strive to extend ratios to all hospitals throughout the state.

“I’m aware we have better staffing than many hospitals outside the city, which is unfair for the patients and staff who don’t have ratios.

“Each and every nurse wants to be able to deliver quality care to patients regardless of where they are treated.

“Ratios are so important to ensure quality and safe patient care, which is our main goal as nurses.”

Lennie says achieving and improving ratios should be the union’s top priority, but it also needs to fight
for a decent pay rise.

“We often work through breaks and stay back to ensure that patients do get the care they need, which takes a toll on our personal lives.

“I think we deserve to be better compensated for making those extra efforts.”

‘Our branch is keen for better ratios’

Mental health nurse and branch secretary Erin Francis has been assaulted by patients twice in the last six months. She has been on Workcover since the most recent assault four months ago, and waits to be cleared to return to her job.

She says her ward’s current one-to-four staffing ratio must be improved to ensure a safer environment for patients and staff, with higher quality care.

“Better ratios would not eliminate the aggression problem, but they would certainly help us to manage it,” she says.

“Having more staff would allow us to run more groups for a more therapeutic and purposeful environment.

“It would make it easier to observe and manage any escalation of aggression and we would be better placed to de-escalate situations.

“And if things got out of hand and someone was assaulted there would be more staff available to help.”

Erin says inadequate ratios are made worse because most staff are relatively junior.

“We have a really poor retention rate, partly due to the geographical location of our hospital in the expensive eastern suburbs.

“We generally don’t keep staff for longer than a few years because most nurses can’t afford to stay in the area. They tend to move to the west and get a job closer to home.”

She thinks improved ratios are the most important part of the union’s award claim but says more nurse educators are also an important demand for a specialised area like mental health.

“More educators are really important, especially in mental health where you’ve got new graduate nurses coming through who haven’t specialised.

“They need a lot of support and often there are not enough senior staff on the floor for them to learn from.”

She says most mental health nurses understand and support the union’s award claim.

“Our branch is quite passionate about pushing the union claims and very keen for better ratios to be delivered, because they would mean so much to us.”