January 16, 2025

nurse-to-patient ratios

Nurses and midwives fired up over insulting pay offer

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A lively crowd assembled in Sydney’s Hyde Park and marched to Parliament House in support of the NSWNMA’s 15 per cent pay claim on 13 November.

The rally coincided with a second 24-hour statewide strike by 10,671 nurses and midwives.

Outside Sydney, rallies were held in Armidale, Broken Hill, Coffs Harbour, Crookwell, Lismore, Moruya, Port Macquarie, Taree and Tweed.

The strike followed eight months of talks with the government including four weeks of intensive negotiations.

Premier Chris Minns told the Sydney Morning Herald the government could not afford to fund safe nurse-to-patient ratios and a pay rise above 10.5 per cent over three years.

NSWNMA General Secretary the  Minns  government’s decision  to  grant  police officers, a 72 per cent male workforce, pay rises of up to 39 per cent while offering nurses and midwives, who are 86.7 per cent women, only a quarter of that amount.

The decision “highlights a stark and troubling disparity” Shaye told the nurses’ Sydney rally.

“Good on the police for getting their historic outcome, but it is clear there is one reality here for male- dominated workforces and another for female- dominated workforces.

“The white-hot rage of the biggest female dominated workforce in this state is bearing down on this government right now.

“The government is making the gender gap worse not better.

“ This government, and every government before it is taking the gender wage gap to the bank – every budget surplus and every minimised deficit has been built on the fact that women in this state have taken lower wages to make that happen.

“Government after government has traded on the goodwill of nurses and midwives to sacrifice their pay for the care of their patients, and we aren’t going to stand for it anymore.”

Shaye said the gender pay gap in the NSW public sector had risen three years in a row to 6.2 per cent – the highest gender pay gap in the last decade.

“This is directly attributable to the wages of nurses and midwives stagnating while male dominated workforces continue to receive pay rises around us.”

‘We won’t pay for better staffing out of our own pockets’

The state government expects that nurses and midwives will  remain  low  paid  in order to staff the hospitals via ratios, said NSWNMA Assistant General Secretary Michael Whaites.

“It is abhorrent to argue that nurses and midwives in NSW should pay for better staffing out of their own pockets. That’s what the Liberals used to say,” Michael told the Sydney rally.

He said that before the 2023 state election the union prioritised safer patient care through mandatory minimum staffing.

“We didn’t ask for higher than average wage rises because the cost-of-living crisis hadn’t hit at that time.”

He said that not even the Reserve Bank had seen the cost-of-living crisis coming. “In NSW we have the highest cost of living – upward of 12 per cent higher than nearby states.

“We have the highest housing prices in the country – 1.5 times nearby states. “Meanwhile, NSW has the lowest wages for AiNs and ENs of any state.

“And once you add in the (recently granted) 3 per cent (interim) wage rise the only state lower than NSW for most RN classifications is South Australia.”

‘I won’t work for less than my interstate colleagues’

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Three years ago, NSWNMA member and theatre RN Nanette Nowakowski from Kempsey Hospital returned to NSW after working in Queensland hospitals – public and private, city and rural- for eight years.

Speaking at the Sydney rally, she sharply contrasted working conditions in the two states.

“Everywhere I worked (in Queensland) the staff were working to ACORN standards and I was surrounded by medical and nursing professionals who valued the standards that should guide our practice,” she said.

“We always had the required staff, and staff were never expected to push beyond a reasonable workload.

“It’s not that every day was a perfect day but I definitely felt valued by every hospital I worked in. I was never made to feel bad if I couldn’t work an extra hour or extra shift.

“In Queensland… nurses are valued with education, supervision and guidance. Nurse educators educate

100 per cent of the time. Nurses are encouraged to know the standards and implement them in their practice.

“When I got to NSW, I was shocked by the pay difference and by the expectation that I will do overtime and sometimes be expected to not claim it.”

She said the NSW government “has money for other essential services but not enough money to properly resource the healthcare system and definitely no money for nurses.”

“It’s time for us to say I’m not afraid anymore, I deserve to earn the same amount as my interstate colleagues and I won’t work for less.”

Interstate pay disparity for midwives

Regional, rural and remote area midwives face “staff deficits, outdated ratios and outdated pay”, Tamworth midwife and NSWNMA member Nami Munikwa told the Sydney rally.

She said midwives just four hours away in Queensland are earning 18 per cent more than her and her NSW colleagues.

“We’re working for a government that encourages our colleagues to move to interstate, retire early or change profession,” she said.

Minns ‘out of step’ with Labor nationally

The NSW Labor government is out of step with Labor government in Queensland, Victoria and federally that have acted to support majority-female workforces in public sector nursing, aged care and childcare, said NSWNMA President O’Bray Smith.

“This (NSW Labor) government got elected on the platform of supporting essential workers. What they meant were just the male dominated workforce,” O’Bray, a midwifery manager told the Sydney rally.

She contrasted the Minns government’s hardline stance against NSW nurses with federal Labor’s support for nurses and other workers in aged care.

“They have also supported early childhood educators in another female dominated industry to get an historic pay rise, recognising gender inequity,” she said.

“Victorian Labor has recognised the undervaluing of nurses and midwives by giving them a once in a generation pay rise.

“The Queensland Labor government implemented proper gender assessment tools that resulted in night shift penalties, overtime rates and pay rates that recognise the gender pay gap and fixed it.”

‘Disrespect will only make us fight harder’

The state Labor government has widened the gender pay gap for nurses and midwives, NSWNMA member Belinda Renshaw, Macarthur Branch, told the Sydney rally.

“I stand here today as a single mother and registered nurse and midwife of 21 years,” she said.

“To make ends meet I work full time 12-hour night shifts, one or two overtime shifts a fortnight and babysit two days a week – all of it possible with the help of my retired mother.

“I tell my daughter every day that she is amazing and can be whatever she wants to be when she grows up, but the reality is that’s not true, is it?

“The state government proves it by perpetuating the gender gap and making it harder for women to reach their full potential.

“Why will you not pay us what we are worth? Your counterparts across the border are doing the right thing.

“Your disrespect will only make us fight harder.”

No deal struck: Nurses and midwives call a second 24 hour strike 

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Public sector nurses and midwives across NSW will go on strike for 24 hours next week, after talks between the NSW Nurses and Midwives’ Association (NSWNMA) and the NSW government failed to reach an outcome on wages.

The NSWNMA notified its members a short time ago, confirming a 24-hour strike will go ahead from the start of morning shift on Wednesday, November 13.

NSWNMA General Secretary, Shaye Candish, said the union had been forced to take this action, after no progress on pay had been made during the four-week intensive negotiation period.

“This strike action isn’t taken lightly, but the government has left us no other choice. It cannot continue to underestimate the anger within the nursing and midwifery professions,” said Ms Candish.

“Our members are extremely frustrated and disheartened. They have been holding on for an outcome on better pay, juggling challenging working conditions, trying to manage their bills in a cost-of-living crisis, and now they feel terribly let down.

“Not only is the state government not willing to put any new money on the table to pay nurses and midwives adequately for the work they do, it also doesn’t have a solution to address the interstate pay and gender pay disparities.

“We have some of the lowest paid nurses and midwives in the country, yet we continue to see record activity in our emergency departments and across the public health system. It’s no wonder nurses and midwives are continuing to move interstate or reevaluate their careers.

“Other female-dominated workers such as teachers, early childhood educators and aged care workers are being valued and well remunerated by Labor governments. Yet the NSW government is happy to let the gender pay gap grow in NSW, which is now the highest in a decade.

“Almost 70,000 public sector nurses and midwives across the state are worse off, and they will continue to slip further down the pay and conditions ladder, if this government doesn’t step up and deliver a decent wage increase for its single largest female workforce.”

NSWNMA Assistant General Secretary, Michael Whaites, said despite repeatedly saying that the wages cap had been removed, the government was refusing to put an offer to nurses and midwives that would address the underlying problems.

“This contradicts the government’s claims that they are trying to fix the gender pay gap or that they had any intention of negotiating with us. Instead, they are just offering the same to our workforce as every other public sector worker and failing to take our issues into account,” said Mr Whaites.

“From May to October, we have showed up to Ministry of Health negotiations and participated in good faith. We identified savings to fund our claims, but no formal offer was made on pay, night duty penalties or salary packaging.

“The government says it’s delivering nurse-to-patient ratios and that it can’t provide a decent pay increase too. The government expects that nurses and midwives stay low paid in order to staff the hospitals. The very real risk is that ratios will be no more than a commitment on paper unless they deliver competitive and attractive rates of pay so they can recruit.

“We are calling on the Premier and Treasurer to intervene and direct new money into the Health budget to address the interstate and gender-driven wage disparity impacting nurses and midwives.

“The government must find this new money, because if it doesn’t, the current recruitment and retention challenges will only worsen. The government cannot afford to lose any more nurses or midwives. It must fix this now, or the public health patients of NSW will suffer.”

Industrial action follows Ramsay’s low offer

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NSWNMA members at Ramsay Health Care have taken industrial action for the first time.

NSWNMA members at Ramsay Health Care launched industrial action for a pay increase and safer staffing in July.

Members at the company’s NSW facilities voted strongly in favour of action in a secret ballot conducted by an independent agency.

They voted between 86 per cent YES and 96 per cent YES to each of 10 specific forms of action.

These ranged from wearing union badges and campaign clothing, to work stoppages of up to four hours.

The company and the NSWNMA Ramsay bargaining committee have held 11 negotiation sessions for a new enterprise agreement since April 2023.

Despite these talks, Ramsay was only offering an 11 per cent pay increase over three years.

This was the company’s second offer, following its original proposal of 9 per cent over three years. The last Ramsay pay increase was 1.5 per cent in July 2022.

LOW-LEVEL ACTIONS COULD ESCALATE

Deanna Hayes, NSWNMA branch secretary and delegate at St George Private Hospital, is a member of the bargaining committee, which includes 10 member-representatives from Ramsay hospitals across NSW.

“We will start with low-level action, such as wearing campaign badges, distributing flyers to patients and visitors, taking our message to the media, and posting information on our social media accounts,” Deanna said.

“We will escalate action potentially to a stopwork meeting if Ramsay doesn’t come up with something better.

“We are frustrated we have to resort to industrial action to be heard. Ramsay is not listening to us, despite telling them all the reasons why their offer is insufficient.

“We are doing increasing hours of overtime and regularly miss out on lunch breaks, as a result of staffing shortages. We worry we can’t provide the care our patients deserve under these conditions.

“We feel extremely undervalued and underpaid. Ramsay needs to pay us what we’re worth, or risk losing more staff.”

Deanna said she had seen some nurses quit in the last 12 months and take jobs in the public sector or at other private hospitals.

Aussie hospitals are Ramsay’s money-spinners

Ramsay is one of the world’s biggest private healthcare companies, with 31 hospitals and clinics in NSW alone. It declared a net profit of $298.1 million for the year to June 2023.

While Ramsay operates in Europe, the UK and until recently, Asia, its Australian hospitals remain its most profitable business.

Ramsay sold its Asia division in December and is reported to be considering selling some or all of its biggest offshore investment, French hospitals group Ramsay Santé.

The Australian Financial Review (AFR) said Ramsay Santé has only ever made one-third to one-half of the profit the company makes from its 72 facilities in Australia.

The AFR said Ramsay might use the proceeds from the sale of overseas assets “to make its Australian business bigger, expanding while smaller and poorly capitalised hospital groups are struggling.”

“They were fed up with Ramsay pay and conditions and how long the enterprise bargaining was taking,” said Deana.

‘NO’ VOTE REJECTS COMPANY OFFER

The vote in favour of industrial action followed a powerful “No” vote in a ballot on Ramsay’s proposed enterprise agreement in May.

Eighty-two per cent of nurses and midwives participated in that ballot, with more than 3500 of them (81 per cent) rejecting Ramsay’s offer.

The NSWNMA is seeking an 18 per cent increase over three years and improvements to conditions, including increases to paid parental and personal leave entitlements, and protection of existing conditions.

NSWNMA General Secretary Shaye Candish said it was disappointing Ramsay hadn’t come to the table with a pay and conditions offer that recognised and valued their employees.

“Ramsay is a very profitable business and continues to build new hospitals and buy others,” Shaye said.

RAMSAY CAN AFFORD IT

“We know they can afford to pay our hardworking nurses and midwives what they’re worth.

“This is the first time our members are taking protected industrial action against Ramsay in NSW.

“This decision is not being taken lightly, but Ramsay has repeatedly refused to come to the table with an offer that reflects the incredible work of nurses and midwives.”

Shaye said Ramsay’s most recent offer of 11 per cent over three years was well below inflation and did not address cost-of-living pressures.

“Under Ramsay’s latest offer, its nurses and midwives in NSW would be paid up to 14 per cent less than their Queensland counterparts.

“Ramsay staff fear they will be paid less than NSW public sector colleagues when their deal is struck.

“Ramsay also refuses to consider staffing ratios, to ensure safe patient care and safe workplaces for nurses and midwives.

“As part of our claim, we want to see shift-by-shift nurse/midwife-to- patient ratios introduced in all wards and units in Ramsay hospitals,” said Shaye.

“Our members are struggling to keep up with workloads due to staffing shortages. It is not safe for staff or patients, and we urge Ramsay to commit to implementing staffing reforms across its NSW sites.”

Shaye added the company was seeking to cut conditions such as eligibility for the higher on-call allowance, no in-charge patient-load hospitals, and weekend penalty rates for casual employees.

Regional ratios rollout welcomed but slow to start

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The NSW Nurses and Midwives’ Association (NSWNMA) has welcomed the announcement of nurse-to-patient ratios at two regional NSW hospitals, to help alleviate pressures on staffing in emergency departments (ED) but has expressed concern over the pace of the phased rollout.

Lismore Base Hospital will receive an additional 29 full-time equivalent (FTE) nurses and Port Macquarie Base Hospital will receive 13 FTE, to meet the ratio of one nurse to every three treatment spaces in the ED.

NSWNMA Assistant General Secretary, Michael Whaites, said it was pleasing to see recruitment would begin for additional nurses at Lismore and Port Macquarie Base Hospitals, and that regional hospitals were included early, but indicated members were frustrated by the slow implementation of safe staffing levels.

“We look forward to seeing these two regional hospitals receive a much-needed boost to their staffing numbers in the ED, which will improve the delivery of emergency patient care on the NSW mid and north coasts,” said Mr Whaites.

“However, only four out of more than 200 public hospitals have started receiving nurse-to-patient ratios since the Labor government was elected last year. We know many hospitals are struggling with staffing shortages and need shift by shift minimum and enforceable ratios urgently.

“We need the Ministry of Health and state government to speed up the safe staffing rollout, to ensure it is implemented smoothly and swiftly. We know hospitals like Coffs Harbour Health Campus, just up the road from Port Macquarie, are crying out for help, and desperately need more nurses to meet ever-increasing demand in their ED.

“Right across NSW, the public health system is struggling to recruit and retain the staff it needs to operate our hospitals due to poor pay and unbearable workloads. As a result, many skilled and experienced clinicians are leaving the profession. Tweed Valley Hospital, north of Lismore, is losing staff to Queensland for ratios and better pay. They need to know when things are going to get better for them.

“NSW nurses and midwives are now the lowest paid in the country. In order to rebuild the workforce and attract staff into the industry, nurses and midwives need a 15% one year pay increase to make their wages competitive with other states.

“The government needs to pay nurses and midwives a wage that values the vital work they do. The longer the government fails to act, the worse it’s going to get. Now is the time to intervene.

“As part of our claim, we are also seeking further funding for nurse-to-patient ratios so every unit and ward in every public hospital receives safe staffing.”

The NSWNMA is continuing to negotiate with the state government on its 2024 pay and conditions claim, after the current Public Health System Nurses’ and Midwives’ (State) Award expired on June 30.

More hands on deck

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Closer monitoring of high-risk patients is one of many benefits expected to flow from the introduction of ratios in EDs.

Ratios will give us more hands on deck, which will take a lot of pressure off the nursing staff,” said  Liverpool  Hospital  ED nurse Mila Calderon.

“Having more staff will benefit patient safety, with closer monitoring of high-risk patients, delirium patients etcetera,” she added.

Mila, who is an NSWNMA delegate for the hospital, said current staffing in acute areas is six patients between two RNs in the daytime and four patients to one RN at night.

“We see a lot more patients than the bed numbers, due to the rapid turnover of patients in ED,” she said.

“The current staffing levels can put huge pressure on nurses depending on how unwell the patients are.

“Sometimes, care is delayed or missed for a while because it gets so busy.

It’s not often that we are able to pull a nurse from a different area to come and help.

“We rarely have a float nurse to give us a hand and when we do, they tend to float between triage and the resus area.”

Mila said, “The NUMs are not always able to stop what they’re doing and give us a hand.

“There are times when we can’t step out for a break during daytime, because it would mean leaving your partner on their own with six patients.

“We sometimes miss breaks at night, too. But since we’re 1:4 overnight, when a nurse goes on break, the neighbouring nurse has to overlook two lots of patients until the other RN comes back from their break.

“Sometimes we only get one break instead of the two we are supposed to have in the 8.5 hours we are on duty.

“You feel that you are drowning with so many things left to do.”

Mila said ED nurses know they would not be getting ratios without the NSWNMA.

“It is obvious to everyone that we finally got ratios thanks to the union.”

She said nurses have been talking about the introduction of ratios and are keen to see how they are going to work.

“Some people are very excited and positive about it, while others are doubting how it is going to work out in certain areas, such as the waiting area and sub-acute, where patients are being looked after by nurses but are not allocated a bed.”

Ratios needed to retain seniors and mentor juniors

President of the NSWNMA’s Royal North Shore Hospital Branch, Corrine Adams, joined General Secretary Shaye Candish and Health Minister Ryan Park at a media conference to announce recruitment for the ratios rollout had begun.

Corrine said safe staffing reforms would help attract and retain nurses and midwives well into the future.

“The staffing ratios won’t only be for our community and for patient safety, but also to help retain our staff and especially to support our novice staff members,” she said.

“We have to ensure we actually support our staff with our senior staff members and at this time, we can see that nursing staff are leaving in droves.

“We want to retain those senior staff members to support our novice staff members to ensure they have a rich career in nursing and midwifery.

Corrine added, “I’ve been a nurse for about 18 years and every year it is harder – especially when

COVID-19 came around. To ensure solidarity and mateship within our crew, it is important that we have staff ratios.”

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