June 27, 2022

RN24/7

Pandemic exposes the vulnerability of under resourced health systems

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A new US study highlights how COVID-19 battered an already poorly resourced and vulnerable health system.

Even before the arrival of COVID-19, US hospital nurses were already struggling with high patient workloads and frequent operational failures, including missing supplies and missing or broken equipment, according to new research.

The study covered over 250 hospitals from November 2019 to February 2020 – before the surge in COVID-19 cases – and the findings were published in the British Medical Journal.

Nurses surveyed in the study gave a damning assessment of the state of their hospitals prior to COVID-19.

“Nearly half give their hospitals unfavourable grades on patient safety, a third give unfavourable grades on infection prevention and almost 70 per cent would not definitely recommend their hospitals,” researchers found.

“The majority of nurses report their work was frequently interrupted or delayed by insufficient staff and a third of nurses report interruptions or delays from missing supplies including medications and missing/broken equipment.”

The study found that half of nurses were experiencing high burnout, and one in four planned to leave their job within a year.

Over two-thirds of nurses would not recommend their hospitals to family and friends needing care, and almost half reported unfavourable patient safety ratings.

Patients corroborated this assessment. A third of patients rated their hospitals less than excellent and said they would definitely not recommend them.

The researchers describe the COVID-19 pandemic as “a real-time example of the public health implications of chronic hospital nurse understaffing”.

“Indeed, the pandemic has highlighted some of the pre-existing realities and inequities within the US healthcare system – among them: understaffed hospitals, a burned-out clinician workforce and poorer health outcomes among racial minorities,” it said.

The study cites other research into the public health implications of nurse understaffing for patients with COVID-19, which found that countries with higher workforce concentrations of RNs had lower COVID-19 mortality rates.

This, it concludes, highlights that “a robust nursing workforce is essential for addressing the current and future outbreaks”.

Sign an open letter to NSW Government’s premier and health minister

The NSWNMA has launched an online community campaign in support of nurses, midwives and ratios.

Nurses, midwives and community members are encouraged to sign an open letter to Gladys Berejiklian and Brad Hazzard. The letter asks them to value the extraordinary contribution of nurses and midwives, and to support them at work and improve patient outcomes by implementing shift-by-shift ratios. To sign the letter, go to:

There are also several videos of nurses talking about conditions on the frontline:

Skye Romer

Jodi Gough

ACTU TV advert in support of essential workers

The ACTU has launched a television advertisement encouraging the public to support essential workers like nurses by getting vaccinated. You can watch the ad here.

 

Finally… action in aged care

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There was a lot to celebrate yesterday – not only was it International Nurses Day and Mother’s Day –  aged care workers received a pledge from a major political party to start taking action on understaffing.

If elected, Opposition Leader, Bill Shorten committed Labor would:

  • ensure there is an RN present, on site, at residential aged care facilities, 24 hours a day
  • require providers to publish the skill mix of the aged care workforce employed at every nursing home and ensure the appropriate skills mix of properly-trained staff is on duty at all times
  • immediately start work on the implementation of the Matter of Care workforce strategy to address understaffing
  • increase training of aged care staff to improve the workforce’s understanding of dementia, including scholarships for nurses and carers to undertake specialist dementia care training
  • provide TAFE places for 20,000 aged care students
  • increase the number of and access to home care packages and increase staffing levels and skills
  • provide incentives for GPs working in aged care

This is a positive step in the right direction, particularly because it recognises the need to take action now in aged care, rather than waiting for recommendations from the royal commission.

There is still a lot of work to do. We need mandated ratios for safe staffing and for government funding to be directly tied to care.

Read comments from NSWNMA General Secretary, Brett Holmes here.

Veteran aged care campaigner bows out

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For the past 16 years, the NSWNMA state council has benefited from Lucille McKenna’s strong advocacy for the aged care sector.

Lucille McKenna steps down from state council – the union’s highest administrative body – this month and will soon retire from the workforce after 58 years as a nurse.

Lucille trained at Concord Repatriation Hospital and worked as a district nurse for Ashfield Council. After a further stint at Concord she embarked on a 50-year career in aged care including continuous service as a director of nursing since 1979.

She has played a prominent part in vital aged care campaigns run by the NSWNMA and its federal body, the Australian Nursing and Midwifery Federation.

They include the RN 24/7 campaign to convince the NSW government to keep the legal requirement that a registered nurse be on duty in nursing homes at all times.

“Our level of engagement with politicians has been high and I note the government still hasn’t removed the RN 24/7 requirement from the Act, which it said it would do.”

“I have lost count of the number of inquiries I’ve given evidence to over the years. They expose problems but don’t always fix them.

“I gave evidence to a Productivity Commission inquiry and talked about the dodgy trainers of Certificate 3 care workers but nothing changed. There are still people offering to provide training over two weekends.”

Government aged care reforms have amounted to little more than bureaucratic reorganisation in recent years, she says.

“They change the deckchairs all the time but conditions inside nursing homes will never improve until they are required to employ enough staff.”

The Hawke Labor government reforms of the 1980s gave aged care its “golden years”, Lucille says.

“Those reforms effectively gave us mandated staffing hours under the care aggregated module (CAM) system.

“Residents were assigned a level of funding to be spent exclusively on direct nursing and personal care. A facility was funded for the total number of hours needed by all residents and managers had the freedom to spread the hours across whatever staff were needed.

“If you didn’t use the money on direct care staff – RNs, AiNs, activities staff, physios and the like – you had to pay it back.

“It was more generous than the current system and gave us the ability to employ more RNs.

“I was running 84-bed Berkeley Village nursing home on the central coast at that time. We had a DON, deputy DON, a full time educator, three RNs on the floor on morning shift plus a part-time RN in pharmacy.

“Now in a facility of that size you’ll probably have someone called a care manager and just one or two RNs.

“The CAM system couldn’t be undermined because staffing records were audited by the Department of Health.

“People actually went to jail for fudging the books – for example, by using CAM money to pay builders instead of nurses.”

Lucille says aged care has been on a “downhill slide” ever since the Howard Liberal government’s Aged Care Act of 1997.

“The Howard legislation removed the requirement for a provider to be a person rather than a corporation. It opened the door for big companies to buy nursing homes and float them on the stock exchange.

“Until the Howard period I could always speak to the owner even if they owned a group of homes. Howard’s changes put a distance between the financial controllers of the business and the operators of the nursing home.

“They reduced official oversight of the management of facilities and allowed facilities to replace RNs with personal care staff.

“We now have a general requirement to provide adequate staff but no requirement to spend allocated money on staffing.”

Lucille says her most important task as a DON was to build a relationship of trust with residents, families and staff.

“Engaging with all stakeholders and always being available to talk through issues with them is the key to running a good aged care facility.

“The average nursing home stay is two years and families need to feel confident and know that their loved one is getting the care they need.

“I always spent a lot of time with families to make sure they felt that the staff and I would look after their family member and that I would make sure it all worked for them.”

Lucille says the NSWNMA leadership has strived to improve union governance since the early 2000s.

“The state council understands its responsibilities better, we are better educated and more informed and our union’s governance is very good.

“The union is financially sound and membership has risen from around 39,000 when I came onto council to more than 66,000 now.

“Our campaigns have mostly been effective; we engage with the community more now and we have made sure that politicians are better informed about the issues.

“We started the Nurse Power fund which gives us the money to do effective campaigning.”

Lucille’s involvement in community life has not been limited to the NSWNMA and the battle for better aged care.

She served as Mayor of Ashfield from 2013-16 and remains a councillor on the recently created Inner West Council.

Letters to the Editor
Share your thoughts on this article or anything else important to you as nurses and midwives by sending a Letter to the Editor.

Four letters are published in the Lamp each month and the letter chosen as Letter of the Month will win a gift card. Please include a high-resolution photo along with your name, address, phone and membership number. You can submit your letter by emailing the Lamp: lamp@nswnma.asn.au

NSW Nationals turn backs on RNs in aged care

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The ongoing delivery of qualified, highly skilled nursing care in NSW residential aged care facilities has been dealt a significant blow, after the Berejiklian Government today refused to keep one registered nurse on duty at all times in high care nursing homes.

On the eve of International Nurses’ Day, lower house Nationals and Liberal Party MPs voted down the Shooters Fishers and Farmers Party bill, which passed the upper house unopposed only last week.

General Secretary of the NSW Nurses and Midwives’ Association (NSWNMA), Brett Holmes, said the government’s decision was shameful and over time would erode the level of quality care provided to some of the state’s most vulnerable aged care residents.

“This is a tragic outcome for families with loved ones in high care residential aged care facilities across NSW and is a clear abrogation of responsibility by the Health Minister and Nationals MPs purporting to represent rural communities,” Mr Holmes said.

“Rather than ensuring a high standard of care is maintained throughout facilities with high care residents, the government has hidden behind an ill-informed argument that small regional aged care facilities would close if the requirement to employ one registered nurse remained in the Public Health Act 2010.

“This spurious argument ignores the fact that regional aged care facilities receive Commonwealth funding for complex and high care residents at the same rate as city-based facilities and at least 70 per cent of all residents are deemed to be high care before entering a site. Small rural or isolated facilities also receive additional special Commonwealth funding.

“Nationals MPs have essentially said their constituents don’t deserve a registered nurse on site 24 hours a day and therefore can be transferred by ambulance to the local public hospital or Multi-Purpose Service to wait in the emergency department for assessment and treatment.

“We have long argued that removing registered nurses from high care nursing homes will erode the safety measures that protect residents and our already stretched public hospital system.”

Nationals Party MPs who spoke against the bill today include, Myall Lakes MP, Stephen Bromhead; Upper Hunter MP, Michael Johnsen; Barwon MP, Kevin Humphries; Port Macquarie MP, Leslie Williams and Coffs Harbour MP, Andrew Fraser.

Mr Holmes said the decision would likely result in significant downgrades in the quality of care delivered and expressed his disappointment on behalf of nurses, midwives and more than 24,000 community members who signed a petition in 2015.

The NSWNMA will continue to campaign at the state and federal level, advocating for quality nursing care and pressuring providers to meet the real needs of vulnerable aged care residents.

Download this media release: Nationals turn backs on registered nurses in aged care

Letter from an aged care nurse to her MP

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Aged care RN Claire from Tweed Heads in the very north of NSW has written a heartfelt letter to her MP Geoff Provest asking him to vote in favour of a Bill in the NSW Parliament to retain the legal requirement for RNs in high needs aged care.

Here is Claire’s letter:

Dear Mr Provest,

I am a resident of Tweed Heads and a Registered Nurse employed in aged care. I was one of a group of nurses and community members who came to see you in your office about 12 months ago (we were Bluecare Kingscliff then). We brought you a signed petition which you committed to take to parliament. We thank you for that.

You spoke from your heart about your personal experience of having your dear mother in a nursing home and that you absolutely agreed that it was imperative that there were RNs 24/7 in nursing homes. You also gave us your assurance that if ever it came to a vote, you would vote to support keeping RNs in aged care facilities 24/7.

I am asking for you to please remember your commitment to the aged and vulnerable, and to those who care for them, and to act with your heart and your values when the opportunity comes in the House tomorrow.

Your support means so much to us, as nurses and carers, and it means even more to the vulnerable aged people that we care for. Additionally the community and families.

Thank you so much Geoff. We will all be so glad to know that we have done all we can to protect our loved ones.

This photo was taken today at some training on Elder Abuse. Many nurses were here on their days off, because we are concerned about our elders and want to do the very best for them.

Kindest regards
Claire B (RN)

You can still make contact with your MP – what you can do if you’re in NSW

What more you can do:

Previously on Nurse Uncut:

Glennis: Letter from an 80 year old retired nurse about aged care

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Eighty year old Glennis, a retired registered nurse and nursing home resident, has written to her MP, to the NSW Health Minister and the Premier, about keeping RNs in aged care 24/7. A Bill to protect the position of registered nurses in nursing homes passed the Upper House of NSW Parliament last Thursday 4 May. The Bill will come before the Lower House this Thursday 11 May.

Here is Glennis’ letter.

Dear Ms Pavey (MP), I am an 80 year old woman living in an aged care facility in Kempsey NSW. I am writing to ask you to reconsider your government’s decision in regards to removing the requirement for registered nurses (RNs) in aged care facilities in NSW.

I am absolutely horrified that you would make such a decision for the people of NSW and for the most vulnerable, being many elderly people like me who rely on registered nurses to assist with their daily care needs.

As a former registered nurse and someone who has voted National Party all my life, I feel I need to speak out about the Liberal/National Government’s decision and rethink my support for your party.

I am an insulin-dependent diabetic with poor eyesight. I rely on registered nurses to administer insulin injections four times a day as well as administer medications, including S8 pain relief. I have recently suffered falls and rely on RNs for assessment.

Many in my facility also rely on the care from registered nurses much more. The registered nurses are constantly busy delivering care, which is often complex and requiring a high level of skill, including palliative nursing. It’s important for residents to have access to RNs 24 hours a day when it comes to end of life care. Having RNs greatly assists us to stay in our nursing home without needing to be hospitalised unnecessarily.

Whilst care assistants do a great job, only RNs have the training and skills to assess residents’ care needs and implement care in greater detail.

In my case, simple things like having an RN be able to administer nurse-initiated medications is important. For example, I was recently prescribed a puffer four times a day to assist my lungs. I needed this more regularly but the careers couldn’t allow me to have more as it was not charted PRN (when required). The RN was able to give this and have it re-charted so I could use it when I needed it.

I suffer from a partially collapsing lung. Not having this medication could have resulted in me being sent to the local hospital via ambulance. Without an RN on duty, there will be many situations where older people will be sent to hospital unnecessarily. RNs assess and implement care to avoid unnecessary hospital admissions in situations such as this.

My question is, what benefit is there for older people or the community in your decision to remove the requirement of keeping RNs in aged care 24 hours a day?

It seems the only benefit is to the proprietors of care facilities and not to the people of NSW.

I feel this is a gross injustice and one which can only work to destroy the quality of care and quality of lives for many elderly people in this state and your government’s decision will no doubt put older people’s lives at risk!

I had to sell my home quickly and take $50,000 less to secure enough funds to pay for my care and now to be faced with the potential of substandard care with the removal of RNs because of your government’s lack of responsibility or understanding in legislating something so simple, yet so important, is a disgrace!

I am seeking a meeting with you before Parliament next week and will be bringing this issue to the attention of my local newspaper and the media. I strongly urge you and your government to support the Bill in the Lower House next week just as your LNP colleagues have respectively done in the Upper House this week.

Minister, I thank you for taking the time to read my correspondence. I need to take a stand on this matter as I feel that whilst I am not in the best of health physically, as a retired RN I have a duty to speak up on such an important health and quality care matter which will impact so severely on many older people and their families in NSW.

Yours sincerely,

Mrs Glennis M.

Cc Premier Berejiklian; Minister for Health Brad Hazzard

What you can do if you’re in NSW

Contact your state MP before Thursday and ask if they are going to support the Bill – or not! Explain why we need RNs 24/7 in aged care and say you want them to support this important bill. You can help prevent a dangerous model of care in our nursing homes.

Find out who your MP is here  and find their office phone number here.

Ring your MP’s office – here are some supporting facts on RNs24/7 to use in that conversation.

Read the timeline of events in the RN 24/7 campaign: Timeline of events – registered nurses in NSW nursing homes

What more you can do:

– Like the Aged Care Nurses Facebook Page
– Follow RN 24/7 in Aged Care on Twitter

Previously on Nurse Uncut: