NSW Election

Labor’s election win changes the game on ratios

June 2, 2023 by Madeline Lucre Leave a Comment

A change of government in NSW is a victory for political participation by nurses and midwives and creates a new pathway for the implementation of ratios.

The Lamp talked to NSWNMA members in the public

health system about the election result and the consequences for public health in NSW.

An opportunity for change

Geoff Hudson, branch president at Albury Hospital, said from his personal perspective, the NSW election result was great.

“My partner [Dr Amanda Cohn] was elected to the Upper House, and is now the Greens spokesperson for Health. She has moved a notice of motion about reinforcing support for our ratios campaign.”

Geoff said Albury branch members were active during the election campaign, with street stalls and letterboxing with flyers for ratios.

“Nurses are very happy with the change of government,” he said.

Geoff said, following the election, his colleagues “are certainly hopeful but we are really just watching, waiting to see”.

“People think there is an opportunity for change to happen now.”

He said the Albury branch voted unanimously for the 2023 claim.

“Certainly, workloads and ratios are the biggest issues,” he said.

“We are in a bit of a unique position in Albury, on the border with the Victorian side a couple of kilometres away. We see a real disparity because they have ratios in Victoria and because they haven’t had the same pay cap that we’ve been subject to.”

Geoff said the branch will continue to engage with the community about our issues.

“Our next step as a branch is to try to get some local media to get ratios back on the agenda. And we want to make sure that all our members are aware of the new claim and what we are asking for.

“My biggest concern going forward is the lack of timeframe around the government making changes. The government has said they will implement ratios – although not the full claim we have asked for – but they have not put a timeframe around that.”

“I’m cautiously optimistic”

Alicia Rodgers, the branch secretary at Nepean Hospital is an RN in the Neonatal Intensive Care Unit (NICU).

She said the election is a step forward in our campaign but we need to maintain pressure or “we won’t be able to make change”.

“I think it is really positive that members across NSW have voted in support of our 2023 claim,” she said.

“I’m cautiously optimistic, but I think there is a lot of work before we get any meaningful change in NICU and Special Care Nurseries.”

“My colleagues in Neonatal Intensive Care Unit (NICU) were subdued after the election. We are, unfortunately, one of the units that didn’t get a commitment from the incoming government to improve nurse to patient ratios.”

She said NICU nurses are asking for ratios of one-to-one in neonatal intensive care, one-to-two in high-dependency units, and one-to-three in a special care nursery unit.

“Critically, we are also asking for access nurses, which some of our adult ICUs have. We are also asking for things like lactation consultants. They are currently not available in all NICUs to support mothers to express milk for their sick or preterm baby.”

Alicia said a group of NICU nurses were able to engage with the new Minister of Health, Ryan Park, at the strike rally outside Parliament House last November.

“We spoke to him about ratios in NICU, and we really impressed on him why ratios are important.

“He told us he was listening, and we really hope he was listening and will have some discussions with his colleagues.

“We would welcome the Health Minister to come and meet with neonatal nurses to get an idea about what happens in NICU and Special Care Nurseries.

“All people in NSW deserve safe care from their nurses and their midwives; NSW should be leading our country in terms of health care, not trailing behind.

Excited but apprehensive

Samantha Gregory-Jones, NSWNMA branch delegate for the Canowindra Health Service, said her colleagues are expecting a change of government to lead to concrete improvements in their health service.

“We are a rural facility – a fifteen-bed facility staffed to run ten with ambulatory care and an ED – and we work with a base of one RN and one EN.

“For us [if the ALP delivers on its promise] it would mean having two RNs on a shift, and a third person all the time.”

Samantha said there was a mixture of feelings after the election.

“We were excited, but we were apprehensive at the same time. [The result] was kind of like we had a bit of a sigh of relief. Initially, my members were saying ‘It means another RN, and it means we are not working in isolation’.”

Samantha said that even though Canowindra is a small service, NSWNMA members were willing participants in the campaign leading up to the election – as was the local community.

“We did participate in the very first strike in 2022. We had all our members involved – about ten of us, and three of us were on shift.

“The community members who came said ‘We’re here because you literally saved our lives, and we are so thankful’.

“For the second strike, we all wore red shirts. On our shifts, we didn’t do anything that wasn’t about saving lives or directly impacting the patients: so, we didn’t make beds, we didn’t do the midnight timesheets.”

Samantha said there was strong support for the NSWNMA’s 2023 claim – inside and outside the hospital.

“We had a one hundred-per-cent-unanimous yes vote. Ratios are so important.

“Our local member, [Independent] Philip Donato, has popped out a couple of times and had a photo taken with us, and is very supportive. That is one motivation to see there is light. And we do feel as if our metropolitan colleagues are lifting us up.”

‘Privatisation is politically dead’

June 2, 2023 by Madeline Lucre Leave a Comment

Voters in NSW followed the trend in other states and rejected the further sell-off of public assets

The NSW Labor victory in the recent state election – when it ruled out any further privatisation of state-owned assets – is the latest in a trend of state Labor parties winning big on anti-privatisation platforms, says the Centre for Future Work (CFW).

“At last November’s Victorian election, Victorian Labor pledged to recreate the State Electricity Commission (SEC). This promise was widely cited as the ‘cut-through’ issue that led to that party’s dominant victory,” said Charlie Joyce, a researcher at the CFW.

Victorian Premier Dan Andrews called for electricity to be run for people and not for profit.

“Privatisation has failed. It’s failed pensioners, it’s failed families,” he said.

Earlier last year, South Australian Labor also returned to government, after only one term in opposition, pledging to return the recently privatised state railway network to public ownership.

In Queensland, Labor Premier Annastacia Palaszczuk’s government has affirmed its opposition to privatisation and supported public ownership.

“Public ownership is popular – and it’s no mystery as to why. Publicly owned enterprises provide consistently cheaper and more reliable services because they are run for public good, not private profit. On the other hand, the owners of privatised services have strong incentives to cut corners and raise prices in pursuit of higher profit margins. This consistently leads to privatised services being more expensive and less reliable,” said Charlie Joyce.

‘Privatisation has failed. It’s failed pensioners, it’s failed families.’

— Dan Andrews, Victorian Premier

Rebuilding of broken health system starts now

March 27, 2023 by Madeline Lucre Leave a Comment

The NSW Nurses and Midwives’ Association (NSWNMA) has signalled NSW Labor’s state election result as a victory for supporters of nurses and midwives.

NSWNMA General Secretary, Shaye Candish, said the outcome would deliver renewed optimism amongst nurses and midwives, particularly those who had been reconsidering their professional careers.

“Thanks to the efforts of our members, our hard-fought campaign for shift by shift staffing ratios across the public health system just took a massive leap forward,” said Ms Candish.

“Finally, we have an incoming government committed to repairing the systemic issues that have been hampering our health services, and to rebuilding confidence and trust within the state’s health workforce.

“Many nurses and midwives who have reduced their clinical hours, changed roles, or left the profession altogether will be able to look to the future with a sense of hope, while those who have been shouldering the weight of our health system will hopefully be energised again.

“We also acknowledge all the community members who have supported our efforts to secure health improvements and the delivery of safe patient care. There is still more work to be done, but the rebuilding can begin in earnest.”

Assistant General Secretary, Michael Whaites, said the change of government would lead to better health outcomes for NSW patients accessing clinical care, regardless of their postcode.

“This is the first step towards meaningful reform for our public hospitals. Phasing in an enforceable shift by shift staffing system will bring benefits to both patients and health workers,” said Mr Whaites.

“We will have plenty of work to do in holding the new government to their election promises, and we are committed to continuing our campaign until all aspects of our ratios claim are implemented.

“We look forward to the decade-old public sector wage cap being abolished, and the return of a fair collective bargaining process for our members.”

The NSWNMA has extended its congratulations to Premier-elect Chris Minns and his incoming Labor government.

COVID dramatically accelerated nurse and midwife shortage

March 9, 2023 by Madeline Lucre Leave a Comment

Even before the pandemic there was a serious shortage of nurses, midwives and other essential workers but the situation has deteriorated markedly in the last few years, new research confirms.

Labour shortages have been on the rise in Australia but dramatically so in essential occupations like nursing, midwifery and teaching, a report by respected labour market academic Professor David Peetz from Griffith University says.

The research he compiled found that by 2022, the number of internet vacancies for “essential” occupations – such as nursing and midwifery – was 98 per cent higher than it had been in 2018. For other occupations the number was just 26 per cent higher than in 2018.

In NSW there has been a progressive worsening in the shortage of registered nurses for more than a decade, with an acceleration over the last five years and in particular during the pandemic.

Internet vacancies for registered nurses trebled between 2012 and 2022 – rising by 205 per cent, with a 125 per cent increase over the past five years and a 48 per cent increase over the two years to 2022.

The report notes a strong gender dimension to essential work: 75 per cent of workers in essential occupations are female, compared to 47 per cent in the workforce as a whole. Some 46 per cent work part-time, compared to 34 per cent in the economy as a whole.

The shortages of essential workers are particularly marked in regional areas, the report says.

Between 2017 and 2022, all internet vacancies grew by 22 per cent in Sydney but by 117 per cent in provincial and rural regions. Vacancies in essential occupations grew by 74 per cent in Sydney but trebled – growing by 203 per cent – in provincial and rural regions, with the fastest growth in the North Coast and Riverina-Murray regions.

“Vacancies for essential occupations are more consequential in provincial and rural regions than they are in metropolitan regions and, in some non-metropolitan regions, advertised vacancies for essential occupations disproportionately dominate vacancies in that region,” it says.

The report notes there have been high rates of dissatisfaction with aspects of work, and high rates of attrition leading to a worsening of shortages. Some job-related factors such as work intensity, burnout and stress may also be contributors, it says.

Conditions of employment – in particular pay – also help to explain labour shortages.

“When employers say there is a labour shortage, it sometimes is better interpreted as a shortage of wages they are willing to offer to attract labour,” the report says.

“As recent public sector pay policies have led to declines in real wages for many people in essential occupations, it is highly likely this has depressed the supply of labour to essential occupation labour markets and thereby promoted labour shortages.”

“An easing of public sector wage restraint could not be the only solution to shortages of essential workers. There is no single solution. But it is difficult to see shortages being overcome in the absence of appropriate changes to wages policy.”

NSWNMA Assistant General Secretary Michael Whaites says the Peetz report is the latest in a long line of studies that reinforce the need for ratios.

“The report clearly shows that NSW nurses and midwives are stretched to the limit. We know that puts lives at risk. We also know ratios save lives.

“The election on 25 March will be pivotal for our public health system going forward. It is vital we all support candidates who support our ratios claim.”

‘The report clearly shows that NSW nurses and midwives are stretched to the limit. We know that puts lives at risk. We also know ratios save lives.’

— NSWNMA Assistant General Secretary Michael Whaites

“It is difficult to see shortages being overcome in the absence of appropriate changes to wages policy.”

Crucial moment for public hospitals

March 9, 2023 by Madeline Lucre Leave a Comment

The people of NSW go to the polls on Saturday 25 March. NSWNMA local leaders tell The Lamp why the public health system is a vital election issue.

The ALP has promised to introduce maternity ratios of one midwife to three mothers and to review Birthrate Plus to ensure babies count.

“The poor state of public health services will be a big issue at the election”

Midwife Elise Spanner and fellow NSWNMA members in Wollongong plan to hold a public forum and community picnic to focus attention on health care, including maternity services, in the lead up to the state election.

“I think the poor state of public health services will be a big issue at the election, especially given what we’ve been through during the pandemic,” says Elise, Delegate, NSWNMA Wollongong Hospital Branch.

“At some level everyone has felt the impact of the system’s weaknesses – the care deficit is definitely on people’s radar.”

Achieving mandatory staff-to-patient ratios is the most important issue for midwives, she believes.

“Heavy workloads are causing a great deal of mental frustration and a lot of burnout for me, my colleagues and among midwives across the state.

“The pressure is so intense that a lot of staff are leaving. Retaining staff is now a real challenge.”

The ALP has promised to introduce maternity ratios of one midwife to three mothers and to review Birthrate Plus to ensure babies count.

“Under the current system, maternity doesn’t have any staffing safeguards – not even the minimal protection of nursing hours per patient day” Elise says.

“We do have Birthrate Plus but each LHD gets to decide how they use the allocated hours. Hospitals can allocate a lot of that time to educator or policymaker roles, for example, rather than putting sufficient people on the floor.

“I might have eight mothers on an average shift, but because babies aren’t counted, that means writing 16 sets of notes, a minimum of 16 obs, and everything else.

“That workload is not reflected in the current staffing system.”

As a NSWNMA local leader Elise has met politicians from different parties over the last few years.

“It’s been very obvious the Liberal Party has no intention of even speaking with us or trying to understand where we are coming from.

“Other parties have at least been willing to have a conversation with us.”

‘The public needs to know the health system has a smart and dedicated workforce that is being undermined by government inaction.’

— Michelle Rosentreter, Delegate NSWNMA Hornsby and Ku-ring-gai Hospital Branch

“The current government has shown a complete disregard and disrespect for healthcare professionals”

Whoever wins this month’s state election needs to think differently about public health services and funding, says Michelle Rosentreter, a senior intensive care nurse and Delegate, NSWNMA Hornsby and Ku-ring-gai Hospital Branch.

“Governments will always face budget constraints, but now they need to ask themselves whether they can afford to maintain the current approach and do nothing,” she says.

“By tolerating constant short staffing and the ridiculous workload demands placed on clinicians, the current government has shown a complete disregard and disrespect for healthcare professionals.

“I don’t know why they feel it’s okay to be as inactive as they have been.”

Michelle says the election is a great opportunity for the next government to step up and invest in public health and the workforce.

She says this can be achieved via a payrise to make nursing a more attractive career and “a staffing footprint that must be recruited to above what we currently have”.

“The next government has got to understand there needs to be incentives and empowerment of the existing workforce.”

Labor has promised to adhere to the latest professional standards laid down by the Australian College of Critical Care Nurses, including access nurses.

Michelle believes the pandemic has helped bring about greater community awareness of public health issues and the system’s limitations.

She says members of the public she speaks to can’t believe that some politicians deny or make light of the system’s failings.

“People can see how busy nurses are when they go to visit their relatives in hospital. Patients don’t want to ring the bell because they can see the nurses are understaffed and overworked.

“And because nurses and midwives took a united stand in support of four massive rallies and lots of independent stopwork actions, they showed the public that short staffing and unsafe workloads are a problem in every community.”

Nurses and midwives should take every opportunity to speak to anyone regarding the system’s challenges and solutions, such as staffing ratios and a pay rise to retain and incentivise the highly trained workforce.

“The public needs to know the health system has a smart and dedicated workforce that is being undermined by government inaction.

“We need everyone to understand that investment is the key – and we need a government that will start to fix things, not just talk.”

‘If you don’t have time to engage with patients and observe them, they will suffer and the health system will suffer.’

— Nick Howson, Delegate, NSWNMA Cumberland Hospital Branch

Healthcare should not be about political parties, it should be about the safety of patients

“Mental health nursing is built around engagement with, and observation of patients,” says Nick Howson, a mental health nurse and NSWNMA Delegate, Cumberland Hospital Branch.

“If you don’t have time to engage with patients and observe them, they will suffer and the health system will suffer.”

Nick says that over the past six years, documentation requirements for mental health nurses in NSW have dramatically changed from short, narrative, handwritten entries and rounding checklists to continuous observational documentation.

“These changes have far outstripped the staffing calculations developed a decade prior and still in use today.”

To ensure acute mental health wards are adequately staffed, the NSWNMA is seeking ratios of 1:3 on morning and afternoon shifts and 1:5 on night shifts.

However, the Liberal government will not even discuss ratios, Nick says.

“The Liberals keep making false and empty promises that something is coming to alleviate the staffing crisis, but have yet to actually announce anything,” he adds.

The ALP has promised to convert all NHPPD wards to shift-by-shift staffing, which Nick agrees is a better system.

However, Labor’s promised ratio of 1:4 would leave mental health acute wards slightly worse off, he says.*

“Currently under the NHPPD the ratio is about 1 to 3.3, though we are rarely staffed to it.

“As a branch and an interest group we have spoken with Labor’s shadow health minister Ryan Park, but we haven’t had much movement on that unfortunately. I don’t believe Labor understands the situation and I think they really need to.

“It wouldn’t cost a great deal more to slightly increase the ratio in mental health and the benefits of that additional bit of time would outweigh the cost.

“In mental health an extra 15 minutes or half an hour with an individual is a huge benefit to them.

“Our patients require significant resources and take up the most time in EDs as repeat presentations and sitting around waiting for beds in mental health units.

“Properly staffing mental health units would have a flow-on effect in making sure there is less stress on EDs.

“Discussions about health care should not be about political parties – they should be about safety of patients and nurses and the benefits to the state.”

*Editor’s note: Labor is promising no unit or ward will be worse off following the implementation.

‘As nurses we need to use our votes far more carefully.’

— Colette Duff, Delegate, NSWNMA Sutherland Hospital Branch

We have some clout and we need to use it

This state election may be the last opportunity to rescue the NSW public health system from its understaffing crisis, says ED nurse Colette Duff, Delegate, NSWNMA Sutherland Hospital Branch.

“I think we have a very small window to make some progress,” she says. “If we don’t get some significant change and some hope into this environment very soon, the resignations will keep mounting up.

“Almost every day, our nurses are leaving or saying they are looking for other jobs. I’m looking elsewhere too. I need some hope and at the moment the current government offers me no hope that anything is going to be fixed.

“We are really overworked and the staff is extremely junior. We don’t have enough senior nurses to support the new grads and look after our own patients.

“I want the juniors to be supported like I was supported when I started my career 27 years ago.

“I remember all these fantastic nurses who mentored me, answered my questions, gave me a hug when I needed it, and I feel bad because I just don’t have the time to give today’s new grads the same support.”

Colette says nurses who raise staffing problems are usually told to “make do” or “reprioritise”.

“That’s insulting – I have a master’s degree in critical care nursing and many years’ experience, and if I say I don’t have enough staff to do the job, then the government should be listening to me and other nurses.

“I can prioritise everyone over the person with the broken leg, but that person is still sitting in the corner with a broken leg and they are a human being who deserves better.”

The ALP has pledged to introduce nurse-to-patient ratios of 1 to 3 in all EDs if it wins government.

Sutherland Shire is regarded as a Liberal Party stronghold, but Colette says locals are increasingly aware the hospital staffing crisis needs to be fixed.

“As nurses we need to use our votes far more carefully. We are a fairly big and influential group of people; we have some clout and we need to use it.

“We need to remind our MPs they are accountable to us, the electorate, and not to the premier or the Liberal Party, who are not listening to us.

“We have to show our MPs that if they don’t look after our interests, we will vote them out.”

Vote for the future of public health

March 9, 2023 by Madeline Lucre Leave a Comment

The state election on 25 March will be a critical moment in our campaign for ratios.

The NSWNMA wants the NSW state election to be a referendum on shift-by-shift ratios, says General Secretary Shaye Candish.

“The election is both a moment for accountability and an opportunity to progress our campaign for ratios,” she said.

“When nurses and midwives cast their ballot on 25 March, we would like you to remember what your lived experience has been like in the workplace over recent years and to vote for candidates who support ratios so we can make things better.

“There is a clear choice between parties that support safe staffing and an incumbent government that clearly does not.

“The Perrottet government does not even listen to nurses and midwives – witness the conspicuous silence after four massive statewide strikes over the last 12 months – and this must change. Without a government that is prepared to listen and to respond to nurses’ and midwives’ warnings, the public health system has a grim future.”

What Labor has committed to

The ALP hasn’t committed to the NSWNMA’s full ratios claim but they have signed up to five key areas, starting with emergency departments. Under a Labor Minns government:

All existing NHPPD wards will convert to a shift-by-shift system. For those currently at 6 NHPPD, a minimum of 1:4, 1:4, 1:7 enforceable on every shift will apply – with an additional nurse designated as “in charge of shift”/“clinical coordinator” on at least two shifts. Assistants in nursing will be additional to the minimum
In EDs there will be a move to a shift-by-shift minimum of 1:3 + triage; 1:1 in resus; 1:3 in EMUs and 1:4 in MAUs. A clinical initiative nurse and assistants in nursing are to be additional to the minimum
In Maternity there will be a full review of Birthrate Plus® in consultation with NSWNMA; shift-by-shift minimum of 1:3 in postnatal wards. Midwifery group practice/midwifery-led models of care will continue
ICUs will be staffed to the latest Professional Standards outlined by the Australian College of Critical Care Nurses, as relevant to the department
Multi-Purpose Services with Level 2 ED open 24/7 will get a shift-by-shift minimum of three nurses, two of whom must be registered nurses and two must be FLECC or ENECC trained.

The Perrottet government’s position

As The Lamp went to print, the NSW Government hasn’t moved beyond its announcement from last year’s June state budget when it claimed it would enhance the public health system with 10,148 additional full-time-equivalent staff.

NSWNMA Assistant General Secretary Michael Whaites says there has never been any clarity about how many new nurses and midwives are within this figure, where they will be allocated, or when they will be recruited, and there still isn’t.

“These numbers include a rehash of previous announcements and include the NSW Ambulance service as well as at least 1600 nurses and midwives from a 2019 announcement.

“There’s no guarantee how many will actually be recruited because the government said it would allocate funds to Local Health Districts to use at their own discretion.

“What we do know is ratios are completely off the table as far as the Perrottet government is concerned.”

Other parties

Both the Greens, and the Shooters, Fishers and Farmers Party have committed to support mandated safe staffing ratios.

When nurses and midwives cast their ballot on 25 March, we would like you to remember what your lived experience has been like in the workplace over recent years.

– NSW General Secretary, Shaye Candish

‘The result of this election will probably either make or break the health system’ — Shane Slade, RN

“Ahead of the state election, we are raising awareness of our ratios campaign in the area around St George Hospital, where I am NSWNMA Branch President. Understaffing is the number one issue for members, along with excessive workloads. People are being pushed over the edge and doing jobs in excess of nursing. There is an incredible incidence of overtime in the ICU, and it is really hard to fill the gaps because you need someone trained.

“There are some critical seats in and near the hospital, such as Kogarah, held by the Labor leader Chris Minns, and the seats of Rockdale and Oatley, and we are trying to speak with as many candidates and sitting MPs as possible about ratios. We are hitting the ground with letterbox drops and going to train stations and handing out flyers there, and having a chat with anyone who has a minute to stop. We are also using social media: our members at St George are putting messages on Facebook, Instagram and Twitter to share with their families and friends.

“We’ve spoken to all the Greens candidates in the area, and they are very committed to supporting ratios if they win. The Labor candidates have committed to five areas, and they call for ‘safe staffing’, so it is a good start, but there is a long way to go. We’re advising people to ask their local candidates and MPs to support ratios fully, and then ask which candidates best support those.

“It is critically important to set up the public system for the next decade. The result of this election will probably either make or break the health system.

“We are generally receiving quite a positive reaction, and there is a lot of public support for nurses and midwives.”