July 3, 2022

ramsay nurses

New Ramsay EA after company-wide campaign

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Member leaders played a vital role in negotiations.

NSWNMA members at Ramsay Health Care have overcome pandemic-related disruptions and obstacles to finalise a new, two-year enterprise agreement.

The NSWNMA started negotiating with Ramsay in April 2021 and staff voted to accept the company’s improved offer in October.

During this six-month period, COVID-19-related lockdowns in NSW forced a shift from face-to-face to Zoom meetings and created other campaign difficulties.

Despite this, a total of 12 Ramsay members from hospitals in Sydney and the regions joined with NSWNMA officials to coordinate the campaign and take part in negotiations.

These bargaining representatives from across NSW ensured members from all Ramsay hospitals had a voice in the campaign.

The new agreement protects all existing conditions and provides a pay and allowance increase of 3.5 per cent over two years with back pay to July 2021.

After the company withdrew its claims for cuts to nurses’ and midwives’ working conditions, Ramsay members voted to accept the agreement.

In the run-up to negotiations the NSWNMA surveyed members to find out what changes they wanted in the new agreement.

A record number of surveys were returned, showing members’ top concerns were improved staffing levels and improved pay.

Missed meal breaks and insufficient notice of rosters were also priorities to be addressed.

The NSWNMA drew up a set of claims focusing on staffing ratios, fair rostering and better pay.

Three negotiation meetings were held before the COVID-19 lockdown in June 2021, which then forced negotiations to go online.

Ramsay wanted cuts to conditions

NSWNMA General Secretary, Brett Holmes, said the meetings gave member leaders the opportunity to speak candidly about staffing and other concerns.

“Despite a hostile attitude from the company during negotiations, our bargaining reps raised many situations where staffing was an issue, backed by examples in support of the claims,” he said.

“During the campaign over 2200 Ramsay nurses and midwives signed a petition calling for staffing ratios, a safer skill mix, ACORN standards, the ability to take meal breaks and fair rostering.

“However, Ramsay flatly refused to consider any of our claims relating to ratios.

“They maintained that their existing staffing arrangements provided safe patient care but refused to provide information on the formula, citing ‘commercial-in-confidence’.”

Ramsay came to the table with their own demands for cuts to working conditions, including greater “flexibility” in rostering, but later withdrew them after members stood together to reject them.

The new two-year agreement will expire on 31 March 2023. It includes the following pay and allowance increases:

  • 1.5 per cent increase backdated to the first pay period on or after 1 July 2021
  • 0.5 per cent increase from the first pay period on or after 1 January 2022
  • 1.5 per cent increase from the first pay period on or after I July 2022.

Ramsay is the largest private hospital operator in Australia, with 72 private hospitals and day surgery units.

‘A lot of people were happy to put their names to the petition, which was signed by over 2200 people.’— Deanna Hayes

COVID-19 lockdown hindered Ramsay negotiations

An NSWNMA member representative on the enterprise agreement (EA) bargaining committee, Deanna Hayes from St George Private Hospital, said COVID-19 made it harder for members to campaign for a better agreement.

“I think the public health regulations and general level of uncertainty during the pandemic made nurses less likely to take action to press their claims. People didn’t know what was happening to their hours, and how COVID-19 would impact the community.

“The COVID-19 lockdowns in NSW interrupted our bargaining process and forced us to meet with management online. COVID-19 caused a hiatus in the middle of negotiations.”

Deanna said it was disappointing the company “cried poor” and claimed it could not afford to pay a substantial wage increase, despite Ramsay’s share price rising through most of the negotiation period.

“Yes, some procedures were postponed, but every Ramsay nurse like me who got redeployed to vaccination hubs or rural areas had their costs covered by NSW Health. And a lot of private hospitals took public patients by agreement with NSW Health.”

According to the Australian Financial Review, Ramsay CEO Craig McNally’s pay tripled to $5.9 million in the 2021 financial year, and the company’s statutory profit is up 58 per cent despite lockdowns.

The Commonwealth government’s $1.3 billion rescue package more than compensated for bans on elective surgery, with Ramsay receiving almost $1 billion in subsidies from governments in Australia and Europe. Even without these subsidies, revenue was up 3.9 per cent.

Around 430 Ramsay nurses and midwives were deployed to support the public health system during the COVID-19 outbreak.

“They claimed Ramsay had their own method for working out safe staffing but wouldn’t say what this was, because it was ‘confidential’,” said Deanna.

“A lot of people were happy to put their names to our petition, which was signed by over 2200 people, because they don’t always get meal breaks due to inadequate staffing.

“They tell stories of being on night duty with just one other staff member and 20 post-op patients.”

She said the company was dismissive of these examples of staffing shortages that the bargaining reps passed on to them from their workplace colleagues.

“We tried to explain it to them numerous times, but they wouldn’t accept that what we were saying
was true.”

COVID-19 lockdown hindered Ramsay negotiations

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An NSWNMA member representative on the enterprise agreement (EA) bargaining committee, Deanna Hayes from St George Private Hospital, said COVID-19 made it harder for members to campaign for a better agreement.

“I think the public health regulations and general level of uncertainty during the pandemic made nurses less likely to take action to press their claims. People didn’t know what was happening to their hours, and how COVID-19 would impact
the community.

“The COVID-19 lockdowns in NSW interrupted our bargaining process and forced us to meet with management online. COVID-19 caused a hiatus in the middle of negotiations.”

Deanna said it was disappointing the company “cried poor” and claimed it could not afford to pay a substantial wage increase, despite Ramsay’s share price rising through most of the negotiation period.

“Yes, some procedures were postponed, but every Ramsay nurse like me who got redeployed to vaccination hubs or rural areas had their costs covered by NSW Health. And a lot of private hospitals took public patients by agreement with NSW Health.”

According to the Australian Financial Review, Ramsay CEO Craig McNally’s pay tripled to $5.9 million in the 2021 financial year, and the company’s statutory profit is up 58 per cent despite lockdowns.

The Commonwealth government’s $1.3 billion rescue package more than compensated for bans on elective surgery, with Ramsay receiving almost $1 billion in subsidies from governments in Australia and Europe. Even without these subsidies, revenue was up 3.9 per cent.

Around 430 Ramsay nurses and midwives were deployed to support the public health system during the COVID-19 outbreak.

“They claimed Ramsay had their own method for working out safe staffing but wouldn’t say what this was, because it was ‘confidential’,” said Deanna.

“A lot of people were happy to put their names to our petition, which was signed by over 2200 people, because they don’t always get meal breaks due to inadequate staffing.

“They tell stories of being on night duty with just one other staff member and 20 post-op patients.”

She said the company was dismissive of these examples of staffing shortages that the bargaining reps passed on to them from their workplace colleagues.

“We tried to explain it to them numerous times, but they wouldn’t accept that what we were saying was true.”

Ramsay backs down on cuts after staff resistance

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Ramsay management came to the bargaining table with their own claims to downgrade nurses and midwives’ working conditions.

Amid the pandemic, Australia’s biggest private hospital operator, Ramsay Health Care, opened negotiations with the NSWNMA by demanding greater “flexibility” in rostering and other measures.

The flexibility, however, was all in the company’s favour.

Ramsay HR sought the right to change rosters with as little as 24 hours’ notice and to roster contracted hours over an eight-week period instead of the current two weeks.

It also wanted:

  • reduced breaks between shifts after overtime from the current 10 hours after overtime to eight hours
  • the right to direct staff to take annual leave with just two weeks’ notice during periods of low activity
  • further restrictions to when meal breaks can be taken
  • an increase in the kilometre range from 20 km to 50 km when asked to work at another site.

Jacky Soucoulis, a theatre nurse in Sydney’s Inner West, was one of 12 NSWNMA members to take part in the negotiations.

She said management was unable to explain how its “flexible” rostering proposal would work.

“It didn’t surprise me that they were trying to take people’s conditions away from them. They seem to care only about their bottom dollar and not their staff,” she said.

“I think they were trying to avoid paying overtime. I wouldn’t be surprised if it raises its head during the next EA.

“It’s not right to force you to take a day off when it only suits the company.

“Nor is it right to work a two-week period and still not get your contracted hours in, so you have to claim annual leave to get
your money.”

Ramsay withdrew its demands at the third round of negotiations.

Members ‘visual’ presence at talks.

Management representatives arrived at that meeting to find the negotiation room at North Shore Private Hospital packed with posters showing nurses holding signs in support of the union’s log of claims.

The signs included “Ratios Save Lives”, “Ratios Not KPIs”, “Enough Staff to Cover Meal Breaks”, “People Before Profit”, “In Charge Without a Patient Load”, and “No to Forced Roster Changes”.

“The staffing issue meant a lot to us because we were fighting for ourselves, our colleagues and our patients to be safe.

“Members have consistently rated staffing as one of their top concerns for a number of years.”

She said management representatives also ignored evidence from NSWNMA members of EA breaches at some hospitals.

“For example, when members raised the issue of some hospitals refusing to pay for missed meal breaks, the company denied such practices ever happened – even when they were given concrete examples.

“Or they claimed these were rare and isolated site issues.”

The COVID-19 lockdown in Greater Sydney and elsewhere put an end to face-to-face negotiations, which were followed by one Zoom negotiation.

Jacky said the lockdown weakened the campaign and made it easier for Ramsay to wind up negotiations.

“Before the lockdown we managed to get over 2200 Ramsay nurses to hand-sign a petition calling for guaranteed safe staffing ratios, safe skill mix, ACORN theatre standards, fair rostering and the ability to take meal breaks.”

Hospital branch meetings also relied on Zoom meetings and online chat services.

Jacky used a WhatsApp group for her branch members, to keep them informed of developments in bargaining meetings.

She said some members were left confused by the company’s communications, especially about the pay offer, thinking it was a 3.5 per cent one-off payment. In fact, it is to be paid between July 2021 and July 2022.

“This shows the need for crystal clear communications,” Jacky said.

Stand together for safer staffing

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Ramsay nurses and midwives call for safer staffing so they can deliver quality patient care.

Ramsay nurses and midwives have embarked on an enterprise agreement campaign that seeks to improve staffing and skill mix in order to deliver safer patient care.

Members’ claims include ratios for the following specialties:

  • Medical and Surgical Wards
  • Rehabilitation
  • End-of-life/Palliative Care
  • Critical Care (Adult and Paediatric)
  • Maternity Services
  • Perioperative Services – ACORN
  • Emergency Department
  • Mental Health
  • Paediatric Beds Staffing
  • Short Stay Wards
  • Nursing Models for Oncology, Dialysis and Infusions.

Members also call for:

  • sufficient staff on shift for breaks to be taken
  • nurses and midwives allocated to patients clinically assessed as needing specialised 1:1 care in addition to the rostered nursing hours and
  • a revision of the midnight census to accurately reflect the needs of patients.

New safe staffing framework

In their claim, Ramsay nurses and midwives seek a “Safe Staffing Framework” that would include:

  • skill mix for each ward/unit should include a minimum 85 per cent RNs for each shift
  • nurses and midwives designated in charge should not carry a patient load and should be additional to the ratios
  • ‘like-for-like’ replacement for all absences including sick leave (see box for full claim).

NSWNMA General Secretary Brett Holmes says the company has always been proud of the “Ramsay Way” – a corporate culture underpinned by the values of  “people caring for people” and with a commitment “to ongoing improvement of patient care”.

Nurses and midwives are seeking changes that are consistent with these goals and will ultimately be beneficial to the company, staff and patients, he says.

“Ramsay is a $14.5 billion company that is highly profitable. It is making record profits, with strong growth in the Australian business expected to continue. The company can afford better staffing and skill mix, which will give safer patient care,” he said.

Brett says the Association consulted extensively with Ramsay nurses and midwives when compiling the claims for the new Agreement and there is an overwhelming message that staffing must be improved. Ramsay are well placed as a leader in NSW to make this happen.

“Nurses and midwives are telling us that the company regularly expects them to do more with less which means tremendous pressure, missed breaks and gaming of the rosters depending on fluctuations in patient numbers.

“There are unrealistic expectations of staff. Overtime is expected. It is expected that you finish your list before a meal breakis allowed.

“But staff have expectations of the company as well. They expect MyTime to be accurate and live up to what it was promised to be: accessible, transparent and reliable.

“They expect to get meal breaks and if they don’t it should be easy to claim a meal allowance.

“And most important of all, they expect to work with enough nurses or midwives and have the right skill mix on their shift.”

Proposed NSWNMA Ramsay safe staffing framework

Proposed NSWNMA Ramsay safe staffing framework

  • Skill mix for each ward/unit should include a minimum of 85 per cent RNs for each shift with the overall shift comprising staff with the appropriate qualifications, education and competency to provide safe patient care.
  • Only nurses providing direct clinical care should be included in the ratios. Positions such as After Hours Managers (AHMs), Nursing/Midwifery Unit Managers (NUM/MUMs), Clinical Nurse/Midwife Educators (CNE/CMEs), Clinical Nurse/Midwife Consultants (CNC/CMCs), dedicated administrative support staff and wards persons should be additional.
  • Nurses/midwives designated in charge will not be allocated a patient load and should be additional to the ratios.
  • ‘Like-for-like’ replacement – all leave absences including sick leave to be replaced by the same skilled staff or higher classification.
  • Nurses and midwives will be allocated to patients clinically assessed as needing specialised 1:1 care in addition to the rostered nursing hours.
  • Where the NUM/MUM/in charge on a shift considers that patient needs cannot be sufficiently met from the nurses/midwives immediately available, the NUM/MUM/in charge will inform the senior nurse/midwife manager who together with the NUM/MUM/in charge will implement a solution including:

– additional hours for part time staff

– engagement of casual/agency staff

– overtime, and/or prioritisation of nursing activities on the ward/unit.

  • There must be sufficient staff on shift for breaks to be taken.
  • Stores and pharmacy always to be available.
  • Additional nurses/midwives will be provided for escort duty.
  • Additional Clinical Nurse/Midwifery Educators will be employed in all specialties and rostered across all shifts.
  • Revise the ‘midnight census’ because it does not accurately reflect the needs of patients.
  • Riskman to be the appropriate tool for reporting unsafe staffing.
  • All facilities to have adequate available nurses with competency in Advanced Life Support.

Ramsay members’ survey: staffing is the number one issue

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Over 1000 Ramsay nurses and midwives feel that the staffing in their ward, unit or theatre does not allow them to provide the quality care their patients need, according to NSWNMA survey results.

73 per cent of over 1400 Ramsay nurses and midwives who participated in a NSWNMA survey said that staffing numbers were inadequate to deliver the quality care that patients need.

‘The greatest challenge is skill mix and short staffing. Management’s solution is to expect more from nurses. Equally, if the patient numbers slightly drop, they cut a nurse which means we don’t even get breaks and we leave late. My concern is that compromises patient care,” said one nurse.

“Burning out nurses who are giving 110 per cent every day, who are not supported and are expected to work in conditions that put patient safety second and the budget first is not smart,” said another.

Other comments on staffing included:

“Something needs to be done, Ramsay keeps cutting absolutely everything. It’s becoming dangerous for everyone.”

“We seem to have less staff with more patients and patients having higher needs.”

“Shifts are changed without staff agreeing.”

Nurses and midwives also felt strongly about having to work through meal breaks.

“Staff often don’t take a proper lunch or morning break. They mostly eat while they are writing notes or working in the staff/doctors room. This is considered normal,” said one.

Rosters were also a contentious issue.

“Rosters are not available in advance. They are often out on a Thursday for the following week so you are unable to plan social events.”

 

Ramsay Enterprise Agreement pay and conditions claims at a glance

  • Safe staffing standards for quality patient care
  • Four per cent pay rise per annum
  • Maintain and protect current wages and conditions in an agreement that applies to all NSW hospitals
  • Tightening of agreement language to ensure Ramsay honour all nurses and midwives’ agreed entitlements and include examples of how it works
  • Valuing nurses and midwives through better pay and conditions
  • Guaranteeing nurses and midwives’ work/life balance
  • Guaranteeing Nurses and Midwives’ Health and Safety
  • Guaranteeing and Recognising Nurses and Midwives’ Professional Education, Skills and Experience
  • Valuing Nurses and Midwives’ Clinical Leadership and Support
  • Getting nurses and midwives’ pay right using MyTime

 

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