December 13, 2024

74th annual conference

Ageing well

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Attitude, diet and exercise are key if we are to age successfully, says Professor Susan Kurrle.

Frenchwoman Jeanne Louise Calment took up fencing when she was 85 and she bicycled until she was 100, when the local gendarme confiscated her bike because her deteriorating eyesight meant she kept running into people.

According to geriatric specialist Professor Susan Kurrle, Calment also drank port daily and she ate nearly one kilogram of chocolate each week until she died in 1997 at the age of 122. She also smoked two cigarettes a day, but because she lived in an upstairs apartment “she walked up and down three flights of stairs to smoke them”.

Speaking at the NSWNMA professional day, Professor Kurrle outlined the latest research on ageing, and what we can learn about “ageing successfully” by studying people such as Calment.

Ageing well is an increasingly important issue as the life expectancy of Australians steadily increases. “We are currently adding a month to life expectancy every year that we live,” says Professor Kurrle, the Curran Professor in Health Care of Older People at the University of Sydney. “Every twelve years life expectancy goes up by a year.”

Australian women can now expect to live to at least 85, “but if we steer clear of chronic disease, that can be at least 90,” she says. “Kids being born today … can expect to live to 100.”

While in theory these numbers should be cause for optimism, much of the talk around ageing is negative, she notes. “The Productivity Commission, our managers, the Ministry of Health, all talk negatively about the ‘grey tsunami’, but I bet there is no-one … that doesn’t want to be part of that grey tsunami.”

What can we do then to age successfully and avoid age-related conditions such as dementia, frailty and sarcopenia (a decline in muscle mass)?

Unfortunately, Professor Kurrle says, one of the most important factors in ageing is one we can’t control. “Longevity is heredity so the first thing you have to have is the right genes.”

There are, however, three other key factors determining whether we age well that we can influence: our attitude, our diet and our approach to exercise.

“Having the right personality is the second thing: being positive, and Jean … was definitely positive. And you can actually change from being a very negative person to being a positive person, and certainly there are programs [to help you achieve that].”

Exercise has multiple benefits

Being physically active is crucial: exercise lowers your risk of a whole spectrum of age-related illness, including dementia, now 
the leading cause of death in Australian women. Exercise also lowers rates of “depression, breast cancer, bowel cancer and frailty,” Professor Kurrle says.

Exercise, both aerobic and resistance training, is also key, particularly in combating sarcopenia – the age-related loss of muscle mass.

“We lose about one per cent of our muscle mass from age 30,” says Professor Kurrle, who assesses elderly patients’ lower body strength with sit-to-stand tests, where she observes their ability to repeatedly stand from a seated position.

The 30-second exercise allows Kurrle to test your quadriceps and hamstrings, which she calls the “independence” muscles. “If they get weak you can’t get in and out of a car and, most importantly, on and off the toilet.”

When these muscles decline “you walk slowly, and you can’t get across the pedestrian light in time. You are much more likely to fall and more likely to end up in hospital. If you are in hospital you are more likely to stay longer and end up in residential care. You are also much less likely to recover well post-operatively”.

The third key factor in ageing well is nutrition, Professor Kurrle says, and she endorses the often-cited Mediterranean diet.

“Increasing fresh fruit and vegetables, increasing your avocados and olive oils and decreasing saturated fat is probably the diet to live longest.”

Contrary to what we might think, our need for protein increases as we age. While we need around 0.8 grams of protein per kilogram of our body weight per day when we are younger, our need for protein grows with age.

“Once you hit 75 you need 1.5 grams per day, nearly double,” says Professor Kurrle, noting that most hospital and aged care meals are often protein-poor.

It is never too late to adopt habits that will promote healthier ageing, says Professor Kurrle, and she recommends doing things that are easy to incorporate into your everyday life (see box).

“It doesn’t matter what you do as long as you are doing some exercise.”

Professor Kurrle’s seven tips for aging well

  1. Do 30 minutes of brisk walking five times a week (you can do it in two lots of 20 or 15 minutes each day)
  2. Go to the gym or buy yourself a set of 2kg or 3kg weights – about $10 from Target – leave them by your kettle and do a set every time you have a cup of coffee
  3. Do some balance training: stand on one leg while brushing your teeth every morning
  4. Stay curious and interested in others: staying mentally and socially active is important
  5. Care for grandchildren: minding grandchildren predicted significantly higher cognitive function in women (two or three days a week is ideal)
  6. Increase protein intake to 1.5 grams per day per kilo of body weight over the age of 75
  7. Decrease saturated fats and increase good oils such as omega -3

Psychological welfare is a health and safety issue

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Employers have a legal responsibility to manage psychosocial hazards, says Dr Carlo Caponecchia.

When managers at one workplace offered staff the opportunity to have a massage at work, the stress levels of employees increased, according to Dr Carlo Caponecchia, an expert in psychosocial workplace safety and a senior lecturer at the University of New South Wales.

“Staff became so tense … because they had to finish all their work quickly before going to get massaged and then come back to finish the work they weren’t able do before they got their lovely massage,” Dr Caponecchia told delegates who attended a recent NSWNMA professional day.

If they aren’t well implemented, wellness and resilience programs can backfire, says Dr Caponecchia. He gave another example of workplaces that encourage employees to bike to work and then don’t provide showers or spaces to park bikes. Even more importantly, he said, wellness programs are too often used to ‘tick a box’ when they should just be one small part of an organisation’s psychological health and safety plan.

“Preventing psychological injury in the first place should be the main focus of a workplace,” says Dr Caponecchia. “Organisations have a responsibility to make sure that what they are doing in their organisation, and their work systems, don’t cause harm.”

Psychosocial workplace hazards can include any aspect of work, including job content, work organisation, reporting relationships and environmental and organisational conditions that have the potential to cause psychological harm. And employers have a legal responsibility to manage them just like any other workplace health and safety issue, says Dr Caponecchia.

“Managing psychosocial hazards is part of workplace health and safety duties. The Workplace Health and Safety act now explicitly includes psychological health, but it was always there implicitly.”

Employers need to apply a basic risk management model to psychosocial hazards, which means controlling hazards at the source, being preventative, and not focusing on interventions that are about individuals, Dr Caponecchia says.

“The assumptions of risk management are that we are being proactive and preventative. We are not sitting around waiting for things to go wrong. We’re predicting them and we’re acting before people are harmed.”

“Rather than just telling people how to get some help with how they are feeling … redesign what is going on in the workplace that is making them feel that way.”

Focus on fixing the workplace

Instead of telling people how to get better or how to deal with workplace issues better, employers should instead focus on fixing the workplace. Too often, however, employers are putting the responsibility back onto employees, Dr Caponecchia says.

“We’d never accept these kinds of individualistic strategies in other kinds of hazards. Where someone works in a noisy work environment, can you imagine ever telling them to just get better and deal with the noise? At the very least we’d give them some hearing protection. And that would be at the very bottom of controls. What should happen is trying to reduce that noise, trying to use a different machine that makes less noise and trying to isolate that person from the noise.”

Often mental health issues and psychosocial hazards are being dealt with under human resources, but they need to be dealt with in workplace health and safety systems, he said. “All the frameworks and the guidance for managing psychosocial hazards are all pointing in that direction.”

Psychosocial factors also contribute to other types of injury, most notably musculoskeletal disorders and manual handling issues, according to Dr Caponecchia. “They are absolutely fundamental to workplace health and safety. They should be one of the first things we should talk about when we are thinking about work and when we are thinking about safety.”

He advises employees to ask questions about whether their workplace treats psychosocial safety as a health and safety issue. “When you go to the safety meeting, asking whether psychosocial issues are included is a very practical first step.”

The language used is important too. Dr Caponecchia recommends avoiding using terms such as ‘complaints’ and ‘grievances’, which make something sound like a personal issue, and instead use the word ‘reports’. “When people are experiencing an issue that is of a psychosocial nature they should be making a ‘report’, not a complaint and not a grievance. ‘Report’ is the language of safety.”

Dealing with psychosocial risks does not have to mean completely overhauling a workplace. “When people hear ‘work’ design they think they need to knock the system down and start again, but it is about making small, manageable changes, talking to people and being collaborative about how work can change. Who could report to who differently? How can the workflow change? It can be about making small changes that make big differences.”

Resources on psychological health and work

Safe Work Australia has issued a guide called Work-related psychological health and safety: A systematic approach to meeting your duties. Issued by Safe Work Australia in 2019.

A new international standard on Safety Management Systems has been adopted in Australia AS/NZS ISO45001. It explicitly says that organisations now have to include how work is organised as part of their safety management. This can include identifying factors such as workload, work hours, victimisation, harassment and bullying, leadership and the culture of the organisation.

Our pressure paid off

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Minister of Health acknowledges NSWNMA role in improvements to public health system.

The NSW health system is “huge” and always under pressure but the contribution of “our incredible staff” helped produce incredible outcomes, the NSW Health Minister Brad Hazzard told annual conference.

“It’s a challenge but we do actually lead the country in most health indicators. I think that is not just because of our massive budget but because of people like you, frontline staff, who are doing their damnest on every single day to get positive outcomes,” he said.

“There are of course big challenges and one of them is the growing population we have in NSW particularly in and around Sydney but in some of our major rural towns as well. And with that growth comes the need for more and more staff.”

Mr Hazzard conceded that the Association played a major role in creating an awareness of staffing issues.

“It is interesting how these things can cut through the bureaucracy and get to a minister. One of the ways is to have your President or Brett (Holmes) or Judith (Kiejda) talking to me about the issues and making sure I’m aware of them.

“Brett and Judith had been conveying the Association’s views for more staff. Of course they were (also) conveying – we didn’t end up agreeing – the issue around ratios versus nursing hours per patient day. They were conveying it very well.”

Convincing Treasury is difficult

Mr Hazzard pointed out that convincing Treasury to provide funds beyond the current $27 billion health budget was difficult.

“The problem I have as your minister and the minister in NSW, when I sit down at the budget table with Treasury, they look at me with steely eyes and say: ‘You realise you are already consuming about a third of the entire state budget on health’.”

“The reality is that because of the hard work that was done by the Association … Treasury, despite the pressures on our budget, agreed there would be another $2.8 billion (for health) over the next four years.

“We’re doing that and we’ve listened to what your Association has said. We can’t agree on absolutely every point but we have listened.

“Also, over the next four years, I have got Treasury to agree – again on the back of your Association who were pushing the issue very hard of the regional hospitals, the smaller hospitals – the Peer Group C hospitals, the Peer Group B hospitals where, of course, it is five and 5.5 nursing hours per patient day in the medical and surgery wards.

“So, Treasury has rolled over on that as well and agreed they will fund over the next four years (an increase) from five and 5.5 to six nursing hours per patient day making it the equivalent of (Peer Group) A hospitals. So you’d agree that is a very big positive.”

Reflections on annual conference

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The Lamp talked to two first-timers and a second-timer on their impressions of the 74th annual conference.

Waste not says Kate

Cooma Hospital nurse Kate Goodman came away from annual conference with a renewed determination to promote reuse and recycling of hospital waste.

Kate, a new graduate in her first year of nursing, was one of three Cooma delegates to conference.

“The conference was brilliant,” she said. “I loved the professional day – particularly the talk by Craig Reucassel, presenter of the ABC TV series The War on Waste.

“He was entertaining while also being factual. I liked the fact that he was open to listening to health professionals talk about their concerns regarding waste.

“During the discussion, one of our members raised the issue of what to do with out-of-date products that are perfectly sterile. I suggested they think about donating them to their local university or hospital education department.

“I know from my own studies that we don’t have a budget to buy materials for teaching purposes. Putting expired products to use in education would reduce waste and help student nurses.

“For example, they are teaching us how to cannulate but we don’t have the actual cannulas or the right kind of vials needed to draw blood. The same goes for sterile dressing packs, wound bandages and the like.”

Kate says Cooma Hospital’s recycling service is limited and not well known among staff.

“The hospital has just four 600L recycling skip bins which rapidly reach capacity. The overflow must wait for the next pick up, which means the bins are full again almost immediately after they are emptied.

“I didn’t know we even had a recycling service. I had to actively seek out this information, which should be common knowledge among staff.”

Kate says the younger generation is very aware of environmental concerns regarding waste.

“You can see this awareness all the way from the kids who are marching for action on climate change through to little things such as people who bring their own cup or drink bottle to work.”

She said Craig Reucassel’s speech was useful because he broke down the process of creating change into a series of steps.

“His message was to start simple, pick something accomplishable and start with that. Start with something you know you can handle, that will get people on board and is really doable.”

A forum for the bush to be heard

For enrolled nurse Greg Cleary, annual conference was a rare opportunity to put an issue vital to remote area nurses directly to NSW Health Minister Brad Hazzard.

Greg works at Wilcannia Multi Purpose Service and went to conference as a delegate of the union’s Far West Rural and Remote branch.

He asked the minister if he was aware of a management attempt to introduce a new model of care that breaches the award and current MPS policy by failing to provide two nurses on night shift for the Level 2 emergency department, while the ambulance is dispatched.

The proposed new model of care would leave one RN with a security officer/cleaner in the hospital while the ambulance is dispatched with a crew comprising an enrolled nurse and Aboriginal health worker – with or without volunteer ambulance officer accreditation.

Greg said this would reduce the current level of care and safety standards and is opposed by the ENs on staff.

Mr Hazzard said he wasn’t aware of the issue and would look into it.

“I was pleased the union took the issue seriously enough to allow me to present our case to the minister and give him an opportunity to respond if he chose to,” Greg said.

“I felt that it was an opportunity for people from the bush to be heard in a state-wide forum.

“Our branch feels very strongly that the proposal puts patient safety at unnecessary risk and will not provide any community benefit.

“It’s driven by a desire to cut costs but all our staff feel it is false economy as well as being unsafe.”

Greg said his question to the minister led to discussions with nurses from other branches who face the same problem.

He said the conference professional day was “highly motivating”.

“I enjoyed the presentation by Isaac Astill, a young activist on the Stop Adani campaign. His grassroots campaigning has helped to unite people from opposite ends of political spectrum, such as the greenies and the cockies.”

A great chance to network

Among the newcomers to annual conference was Nepean mental health branch secretary and delegate Aislynn Kearney.

Aislynn said she found the whole conference very useful.

“Being able to learn from many other members and feel a part of a much bigger union collective was so beneficial,” she said.

“The best part was being able to meet co-workers and build networks with other branches. I learned more about how to deal with certain issues that mental health branches face, such as getting an activities nurse on each shift or improvements to the duress system.

“I was able to speak with nurses from other branches who had dealt with those issues in the past and had some ideas and suggestions about them.

“The professional day was really interesting and a lot of the presenters had fascinating ideas to share with us – ideas that could help us further the nursing profession and our union goals.

“Nurses face many issues around conditions of patient care and working conditions for nurses on the ward. Sometimes, dealing with those issues can feel like an isolating uphill battle.

“It was encouraging to hear from other branches who are going through the same thing and to know that we can work together.

“It was my first annual conference and I recommend anyone who gets an opportunity to attend a future conference should do so.”

Aged care campaign racks up gains

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Better aged care staffing is firmly on the public policy agenda after a year of strong campaigning by nursing unions around the country.

Nursing unions around Australia have made significant progress in their national campaign for aged care staffing ratios, the NSWNMA Annual Conference heard.

Annie Butler, federal secretary of the Australian Nursing and Midwifery Federation (ANMF), said the public was increasingly aware that nursing homes were not properly staffed.

“Over last 12 months, ANMF members have campaigned across the country, in big cities and small towns, seeking support from the public and commitments from politicians,” she said.

The staffing campaign had achieved a number of important gains over the past year and the ANMF was now “fully engaged” with the royal commission into aged care quality and safety.

The commission had heard the union message on staffing “loud and clear” and commission hearings had received a lot of media coverage.

Annual conference delegates responded with a round of applause when Annie said: “Two NSW assistants in nursing stood up for their residents and gave evidence to the royal commission and I think their courage deserves to be recognised.”

She said political support for aged care ratios was growing.

Just over a year ago, only one federal politician – Senator Derryn Hinch from Victoria – had pledged support for the ratios campaign.

By the May 2019 federal election, 96 politicians had officially signed up to the campaign.

“The federal election outcome wasn’t the outcome we wanted,” Annie said.

“We had no commitment from this government – and we got a half-way commitment from the ALP – but we do have some allies in this government.”

Two nurses now in federal parliament

Annie said there were now two nurses in federal parliament – independent MP Helen Haines, a former nurse practitioner and midwife, and Ged Kearney, the shadow assistant minister for aged care and skills who is a former secretary of the ANMF.

“We will continue to work with them and other alliances we have been building with other nursing and midwifery groups, other health professionals, and the wider community.”

She said ANMF branches had made staffing gains in health care sectors outside aged care.

Victorian nurses had secured improvements to their ratios legislation to deliver another 600 nurses and midwives for the state.

Queensland nurses had secured funding to make 400 nurse navigator positions permanent.

And in NSW, at a local level John Hunter Hospital nurses had shown the way by winning additional staff for their emergency department.

Privatisation battles ‘point the way’

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Unions must learn how to win campaigns that encourage more young people to join their ranks.

Successful campaigns to stop privatisation of regional hospitals in NSW have shown workers they can win industrial battles when the union movement is strong, ACTU Secretary Sally McManus told annual Conference.

Sally said unions must “give people hope that things can be better, that jobs can be more secure, that we can win fair pay rises, or, like you did, that privatisation is not inevitable and can be stopped.”

“Unless people believe things can be better, it’s hard to get them on board to push for positive change.”

In recent years, NSWNMA members have led community campaigns that stopped the NSW government from selling five public hospitals: Wyong, Goulburn, Shellharbour, Bowral and Maitland.

The state government abandoned the privatisations due to fierce public opposition.

Local communities backed their nurses and made it clear they did not want their public hospitals turned into profit-making operations.

Sally said the union movement had to learn lessons from the failure of its “Change the Rules” campaign at the May federal election.

“We have to learn from our setbacks and keep going,” she said.

“One of the lessons I take from the last election campaign and Change the Rules is that it is going to take much longer to win over enough of the general public to our cause.

“We need to take stock of our messages to the public. Do we need to make things simpler?

“Every day, workers are having their wages stolen or are struggling in insecure work. Or they can’t pay the bills because they haven’t had a pay rise for years.

“Most of these people are non-union members. How do we 
speak to them and bring them to 
our movement?

“If we do nothing, union membership will continue to decline and workers’ rights will continue to go backwards.”

Unions need to inspire

Sally said young people were repeatedly told that casual work “is just the way things are, or it is just the way the world is going”.

“They are even told it’s their choice or their fault that they don’t have jobs with rights.

“We need to inspire them and show them that change is possible and change comes through the 
union movement.

“I have seen young people all of a sudden join campaigns and unions and take part in protests outside cafes that aren’t paying people their legal entitlements.

“They are sending a message to other young people that ‘We don’t have to put up with this anymore.’ ”

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