September 18, 2024

rural nurses

What you need to know about the NSW government’s Rural Health Workforce Incentive Scheme

by Leave a Comment

In the lead up to the NSW budget, the NSW government announced it would commit $883 million over the next four years to attract and retain staff in rural and regional NSW. Swift action needs to be taken to address systemic problems across rural and regional health settings, and this announcement has clearly resulted from the sustained pressure of your collective actions, and the damning findings of the Upper House Inquiry into health and hospital services in rural, regional and remote New South Wales.

The Ministry of Health initially sought some feedback from public health unions on this initiative, but without any further consultation, the Ministry recently released the Rural Health Workforce Incentive Scheme policy directive.

This policy directive sets out the bare bones of the scheme, with the following key ingredients:

  • Rural and regional hospitals and services will be classified using the Commonwealth Department of Health’s Modified Monash Model, and the incentives will be potentially available to those identified as being MM3 to MM7. This categorises the value of the incentive that could be applied to a position or a class of role ie either $5,000 or $10,000.
  • Other locations may be deemed rural and remote by the Ministry of Health, taking into account unique location attributes that present challenges to attraction and retention of the health workforce.
  • To have the incentives applied (recruitment or retention) to a specific position or class of role in one of the above locations, they will need to be identified as being hard to fill or a critical vacancy.
  • A range of incentive options may be used to tailor the recruitment or retention package that suits the individual. The Associations understands this is not necessarily intended to be a one size fits all approach.
  • This includes a right to return to your substantive position if only undertaking a fixed temporary secondment or consideration of a priority transfer to a preferred location.
  • Certain constraints would apply to an individual wishing to leave an incentivised position prior to its term concluding, with possible repayments required.

Members are encouraged to read through the detail of the policy directive. This announcement could be an important step toward recognising and addressing the crisis in rural and remote NSW hospitals and health services and it is disappointing this process was not undertaken in a more transparent and collaborative fashion.

We are currently seeking clarification and further answers from the Ministry and will update you when we know more.

The NSWNMA has compiled some answers to questions members may have about the scheme:

Where did this new scheme come from?
Leading up to the NSW Budget, the NSW Government announced it would commit $883 million over the next four years to attract and retain staff in rural and regional NSW.  However, the release was big on headlines and light on detail.

Why now after all these years?
There is absolutely no doubt that the sustained pressure of Association members, and the damning findings of the Upper House Inquiry into health and hospital services in rural, regional and remote New South Wales, meant the NSW Government could no longer avoid this longstanding and endemic problem.

How will this scheme to be applied in the NSW Health Service?
The Ministry of Health recently released the Rural Health Workforce Incentive Scheme (PD2022_025). This sets out the broad framework of the scheme, along with its key features.

Did the Association have any input to this new policy?
Whilst the Ministry of Health initially sought some feedback from public health unions on this initiative after the NSW Government’s announcement, unfortunately without further consultation or receiving answers to the many questions we posed, the Ministry released the policy directive.

Where will the incentive schemes be applied?
It will only apply to locations in NSW outside the metropolitan and regional city centres and their immediate surrounds.  Rural and regional hospitals and services will be classified using the Commonwealth Department of Health’s Modified Monash Model, with the incentives potentially available to those identified as being MM3 to MM7.  For example, Wagga Wagga would be classified as MM3, Mudgee MM4, Lockhart MM5, Nyngan MM6 and Bourke MM7.

Other locations may be deemed rural and remote by the Ministry of Health considering unique location attributes that present challenges to attraction and retention of the health workforce.

What roles will potentially be included in any incentive?
Firstly, it will only apply to roles undertaken by employees of the NSW Health Service, and excludes contractors, agency nurses, Visiting Medical Officers or contingent workforce who are not paid through the NSW Health payroll.

Secondly, to have the incentives applied (recruitment or retention) to a specific position or class of role, they will need to be identified as being hard to fill or a critical vacancy as defined under the policy directive.

What is the value of the incentives?
The value of the incentive that could be applied to a position or a class of role will be either $5,000 or $10,000, depending on the MM rating and whether the position is hard to fill and / or critical to service delivery.  Additional benefits over and above this amount can be considered in certain circumstances.

What type of things could the incentives be used for?
Examples used in the policy directive (noting some are dependent on the MM rating applied) include:  professional development; computer/internet reimbursement; additional personal leave; additional base salary; reimbursement of utilities; family travel assistance; transfer incentives (see below); study assistance; or a cash bonus.

What are the transfer incentives mentioned?
This includes a right to return to your substantive position (or like position) if only undertaking a fixed temporary secondment.  However, it does also include consideration of a priority transfer to a preferred location nominated by the worker at the conclusion of the secondment.  This would need to be agreed prior to commencing the incentivised engagement and have Ministry of Health approval.

Who decides the makeup of any incentive package?
A range of options may be used to tailor the recruitment or retention package that suits the individual ie it is not necessarily intended to be a one size fits all approach (as understood by the Association).  You should have a say in how you would like the incentive used.

Can I leave an incentivised placement early?
Certain constraints are applied if one was to leave an incentivised position prior to its term concluding, with repayment requirements possible.  However, it may be possible to transfer to another incentivised role and maintain the incentives in place.

What happens next?
Members should check out the policy directive whilst the Association seeks to have the many unanswered questions clarified by the Ministry.

Delta unmasks rural neglect

by Leave a Comment

The Berejiklian government plays the blame game as Sydney’s Delta outbreak spreads to regional areas with under-resourced healthcare facilities.

According to the NSW government, the Delta variant emerged on 16 June, when an air-crew driver working under lax NSW Public Health Orders that did not require him to wear a mask or be vaccinated, was diagnosed.

By then, the driver had visited a dozen sites in Sydney’s eastern suburbs. Gladys Berejiklian waited until 25 June before imposing a light lockdown on parts of the city’s east. The virus seeded into Western Sydney.

Loose regulations allowed movement between Sydney and the rest of NSW: for work, to look at real estate, to get COVID-19-tested, or to visit a second residence, for example. Delta subsequently spread across the state.

Rural communities with limited and under-resourced healthcare facilities have been grappling with the consequences.

Healthcare services for people outside of Sydney were dire even before COVID-19. This was made clear in a December 2020 sub-mission from the NSWNMA to a state parliamentary inquiry into health care in rural, regional and remote NSW.

The NSWNMA submission said: “It is not acceptable that residents in the rest of NSW are provided with an inadequately resourced, substandard system of healthcare while metropolitan Sydney residents enjoy far superior access and outcomes.”

It made 24 specific recommendations for improvements, including boosting nursing numbers at sites with no doctor to ensure a minimum of three per shift – two of whom would be RNs. It also recommended better staffing of emergency departments and recruiting more nurse practitioners.

Remote indigenous communities with higher rates of chronic illnesses such as diabetes or kidney disease and shamefully low vaccination rates – a shared federal and NSW responsibility – are particularly vulnerable to COVID-19.

“Indigenous Australians were one of our greatest concerns at the start of this pandemic,” Prime Minister Scott Morrison said in December.

Morrison’s actions failed to match his rhetoric.

Despite Aboriginal people over 12 being prioritised as 1B in the rollout, only 6.3 per cent of the Aboriginal population in Western NSW was fully vaccinated by 26 August, compared to 26 per cent of the non-Indigenous population in the region, ABC News reported.

Aboriginal communities dangerously exposed

Human Rights Watch accused both the federal and NSW governments of leaving Aboriginal people “dangerously exposed to COVID-19 with limited access to vaccines”.

The Maari Ma Aboriginal health service in the Far West warned both the NSW and federal governments in March 2020 that they needed to urgently prepare for an outbreak.

However, the Berejiklian government refused to take any responsibility.

Health Minister Brad Hazzard agreed the vaccination rollout to Aboriginal communities had been “challenging”, but said it was a federal government responsibility.

As The Guardian’s Anne Davies wrote: “The NSW Government’s response (to the worsening Delta crisis) has been a blame game … When it comes to the state’s role there is a stubborn reluctance to admit there may be a better way.”

On Aboriginal health, the NSWNMA submission says Aboriginal people in regional, rural and remote parts of NSW should have access to Aboriginal Community Controlled Health Services.

Epidemiologist Dr Peter Malouf, from the Aboriginal Health and Medical Research Council of NSW, told a parliamentary inquiry into the pandemic that the state government was “very lacking in engagement, particularly listening to the voices of Aboriginal people”.  

The remote settlement of Enngonia in north-west NSW has no hospital, no resident nurse, and no shop. Its mostly Aboriginal residents must travel 97 kilometres to Bourke for health care and groceries.

By the third week of September, COVID-19 had infected 25 – or about one third – of the township’s indigenous population, said Tannia Edwards, CEO of the Murrawarri Local Aboriginal Land Council in Enngonia.

The virus had also claimed the life of a beloved elder.

Ms Edwards told The Lamp that vaccinations were not provided at Enngonia until shortly before the township’s first infection, which followed positive cases in Bourke and Dubbo.

She said vaccination should have started once the virus reached Dubbo, almost 500 kilometres away, because Enngonia residents often travelled there on public transport.

She said government health messaging on COVID-19 had been poor.

“It’s not people’s fault they weren’t getting vaccinated. We needed better messaging, because not everyone can understand what’s happening on TV.”

She said it was hard to self-isolate when as many as 12 people could be living in a four-bedroom home.

“It’s not possible to tell small children they’ve got to stay in a room for 14 days. It’s not possible, and it’s cruel.”

She said rural fire service volunteers were doing a great job, delivering food parcels to the community.

Health service manager for the Bourke Aboriginal Health Service, Claire Williams, told The Guardian the public health response to Delta was “chaotic” and said it wasn’t clear who was in charge.

The Aboriginal Health Service is running a vaccination clinic in Enngonia and delivering medicines.

Western NSW Local Health District said it was doing “routine COVID-19 testing” in Enngonia and had begun “a household-by-household assessment of the community’s health and social needs”.

It said COVID-19 vaccination of indigenous Australians was a federal responsibility.

Understaffed rural hospitals brace for COVID-19

by Leave a Comment

COVID-19 is yet to infect the twin townships of Harden and Murrumburrah, but the local hospital already struggles to find enough nurses.

Nurses at Murrumburrah-Harden District Hospital, about 350 km south-west of Sydney, are in “a heightened state of preparedness” for any COVID-19 outbreak, says RN and clinical nurse educator Marilyn Wales.

“We conduct ‘desktop’ scenarios all the time,” Marilyn says. “What do you do if you get a potentially positive presentation, or a staff member develops symptoms? What do you do if you see a breach of PPE?”

“The reality is that COVID-19 is going to come out to small country hospitals like ours. Essential workers pass through our town all the time and stop for meals and fuel.”

An “essential worker” who visited Harden-Murrumburrah, population 2000, later produced a positive result but there was no local transmission.

Marilyn is secretary and delegate for the NSWNMA’s Harden branch. She shares ideas with NSWNMA members at hospitals across the state through fortnightly webinars and other teleconferencing.

“Every facility talks about staff shortages and inadequate skill mix and how hard it is to attract staff – especially experienced nurses – to small rural hospitals.

“Murrumburrah-Harden’s casual pool is very limited, and we often have difficulty engaging agency staff, partly because of COVID-19 restrictions.

“The nursing population is ageing and we are losing senior nurses who are FLECC (first line emergency care course) trained. That training gives us the ability to use the rural adult emergency care guidelines and administer certain drugs in the absence of a doctor.

“Senior nurses who leave are often replaced by RNs who have just completed their graduate year. They are put in charge of a hospital on weekends and nights with no doctor. That is just asking for trouble.”

Murrumburrah-Harden Hospital has nine acute beds and 20 residential aged care beds. It has a VMO on call.

Like many small sites, the RN in charge of the acute ward is also in charge of ED.

“If we had a respiratory presentation and had to isolate that person, it would take a staff member away for the entirety of that presentation,” Marilyn says.

“We don’t have the staff rostered on to manage that.

“If we get a COVID-19 case, one or more staff members may have to isolate for the required 14 days. If we take out two or three staff, we could be at service failure, because we don’t have the clinical staff resources to replace them.

“My heart broke when I heard that the department was thinking of fast-tracking students into hospitals. It’s an awful atmosphere to ask someone to start their career – in a pandemic.

“Students are already at risk of not being able to register with AHPRA (Australian Health Practitioner Regulation Agency) due to incomplete placements.

“Another government proposal was to bring back retired nurses. People retire for a reason and to bring them back and put their physical and mental health at risk is a big ask.

“Our Premier keeps saying our health system is coping. But staff are having to work 12- or 16-hour shifts and work on their RDOs.

“We might be coping at the moment, but we are not functioning in the proper manner, to the best of our abilities. For us to function we need to have enough staff with the required skills.”

Marilyn, who has nursed in Temora, Narrandera and Murrumburrah-Harden hospitals for 51 years, says she’s concerned for all nurses at this time.

“I’m especially concerned for the girls in Sydney. I cannot comprehend what some of them are going through.”

Country hospitals lose doctors and senior nurses

by Leave a Comment

What does it mean for a nurse to be made responsible for a hospital with no doctor?

Wee Waa Community Hospital, 576 km north-west of Sydney, is a 15-bed acute care hospital with a 24-hour ED.

Like many small health facilities in NSW, it has no regular Visiting Medical Officer and has lost its on-call GP. Occasionally, a locum is found to cover weekends.

At all other times, Wee Waa relies on nurses. The ratio is three on morning and afternoon shifts, and two on nights.

Often, however, only two nurses can be found to cover mornings and afternoons because the hospital can’t recruit enough staff – a common problem in small towns.

RN and NSWNMA member Susan Marshall has worked at Wee Waa hospital for 27 years. She says that since it lost its on-call GP, the hospital has found it harder to keep senior nurses and attract agency staff.

“When there are only two nurses on the ward, and they attend an ED presentation, they sometimes have to ask the domestic staff to keep an eye on the high-care patients.

“Two nurses are not enough, for example, to resuscitate a patient and cover the ward as well as make calls to a telehealth doctor.”

Some senior nurses have FLECC (first line emergency care course) qualifications, which allow them to initiate higher levels of assessment and treatment.

However, nurses often feel intimidated and vulnerable due to the absence of a doctor, Susan says.

“It seems the government wants staff to be FLECC-trained to plug the gap left by the doctor, but it’s not entirely safe.

“If you must work outside your scope of practice to get the job done, you can feel insecure.

“Not feeling professionally secure in the workplace can lead to unhappiness with the job – and many senior nurses have left.

“I feel I’m doing a job that’s not always recognised – and I don’t always feel supported by the system.”

Teleheath not enough

Susan does not believe that telehealth can always fill the gap created by the absence of a doctor.

“There will always be cases when you need a doctor on site.

“We are supposed to call the ED doctor in Tamworth, but they often don’t have time for a Wee Waa problem, though they are sympathetic to our predicament.

“I have rung them with triage 1 and 2 patients, and they say, ‘I’m running a resus here and I haven’t got time for you.’ Their workload has increased because we no longer have a doctor.”

Susan says having no medical coverage has led to more patient transfers – sometimes to Narrabri (30 minutes away) but mostly to Tamworth, which can be a six-hour round trip.

“This puts pressure on the ambulance service and leaves our community very exposed without ambulance cover.”

COVID-19 would be the last straw

It also puts more pressure on Wee Waa’s nurses, who are sometimes questioned by ambulance control over whether a transfer is necessary.

“The ambulance coordinator will say, ‘Do you really need to transfer this patient? I don’t have an ambulance to do it and my staff are on overtime.’

“To have to debate this with the ambulance coordinator, who isn’t local, is frustrating and eats up time that we don’t have.”

Wee Waa has so far been free of COVID-19 but if it strikes the hospital, “it could be the straw that broke the camel’s back,” Susan says.

“If someone had to get all PPE’d up to look after a possible COVID-19 presentation in ED, they would not be able to float back to the ward.

“If one or more nurses went into isolation, the department would have to draw staff out of a higher population area or reduce services.

“Compensating within the current roster is just not possible – even with overtime.”

Susan says the hospital has enough PPE, but staff are still waiting for fit testing to be provided.

More student nurses needed for the bush

by 1 Comment

New efforts to promote nursing careers outside the main cities are needed to encourage graduates to work in rural areas according to new research.

Nursing students know little about initiatives and incentives aimed at reducing the shortage of rural and regional health professionals according to a study commissioned by Rural Health Workforce Australia.

Universities should increase the number of places in their nursing and allied health programs for rural and remote students to help tackle the shortage of health professionals outside metropolitan Australia, it says.

The report calls on universities to boost the number of rural clinical placements available to students and the amount of rural health practice content in curriculums reported The Australian.

Researchers claim there is a lack of awareness of the practice opportunities in rural areas among students and teaching staff at urban universities.

They point out that the federal government does not fund rural placements for nursing and allied health students to the same extent as it did for medical students.

“Doctors are important but they’re not the only answer to addressing the disparity in health outcomes between rural and metropolitan Australia,” says Dr Tony Smith, deputy director of Newcastle University’s Department of Rural Health.

Experts say the recent $4.2 million cut to annual Commonwealth scholarships for allied health will exacerbate the shortage of health professionals in the bush.

 

Wee Waa nurses speak up for patient safety

by

Fed up with delays as a result of medical staff shortages at the local hospital, members of Wee Waa Community Hospital Branch of the NSW Nurses and Midwives’ Association (NSWNMA) have raised their concerns directly with Hunter New England Local Health District and management.

Acting General Secretary of the NSWNMA, Judith Kiejda, said fortunately local nurses’ concerns have been heard and improvements at the hospital are imminent.

“For a number of weeks, doctor shortages at Wee Waa Hospital have created flow-on implications for hard-working nursing staff and the delivery of safe patient care to the local community,” Ms Kiejda said.

“Our members were forced to deal with these implications firsthand and have spoken out on behalf of the community, calling for the underlying issues to be addressed as a matter of urgency.

“Hospital management and Hunter New England Local Health District have a duty of care to maintain a high standard of patient safety, as well as access to adequate medical coverage within this vital public health service.

“Fortunately, management has since sat down with local nurses and agreed to a number of measures aimed at mitigating the issues and will also implement steps to help prevent a reoccurrence.”

NSWNMA Organiser, Jo-Anne McKeough, said local nurses were pleased their concerns regarding patient safety had been acknowledged and confirmed they would continue to monitor the situation.

“We want the community to know nurses have been advocating on their behalf,” said Ms McKeough.

“We’ve expressed the widespread frustration at how these issues eventuated, but also the length of time it’s taken to address them.

“Management has given us assurances they are in the process of implementing new measures to address the current medical shortages and other policies will be put in place to limit the flow-on implications for nurses and other hospital staff.

“The branch will certainly be involved in the process to improve the current Business Continuity Plan, localised escalation plans, the upskilling of staff, as well as how the facility coordinates with other hospitals in the region.”

The NSWNMA confirmed it would continue to support Wee Waa Community Hospital Branch until all their concerns were addressed and services were restored to the local community’s satisfaction.

Download this media release: Wee Waa nurses speak up for patient safety

Verified by MonsterInsights