witness statement

Midwives’ work is increasingly complex

December 5, 2025 by lvo@nswnma.asn.au Leave a Comment

Erin Bonett graduated as a midwife in 2018. She resigned from her permanent position with NSW Health in 2025 and moved to Mount Isa, Queensland, where her contract to work as a midwife comes with a “significantly higher” salary and free accommodation.

In her witness statement, Erin outlined:

The main thing that has changed in midwifery from 2018 to 2025 is the complexity of the women giving birth. More women are getting pregnant who previously wouldn’t get pregnant, due to advances in technology (such as women with fertility issues falling pregnant with IVF) and it is hard to care for them.

Previously we had “high risk” patients now we have “high high-risk” patients.

For example, women with low platelets are now getting pregnant and having the baby, which is a very risky pregnancy… gestational diabetes (diabetes for the first time during pregnancy), is a risk factor for preeclampsia, and has also increased with unhealthy lifestyles in the overall population.

Women with low platelets are now getting pregnant and having the baby which is a very risky pregnancy…

Gestational diabetes… [i]s a risk factor for preeclampsia and has also increased with unhealthy lifestyles in the overall population.

Women with polycystic ovarian syndrome, who previously struggled to get pregnant and are now getting pregnant with IVF, are at a higher risk of gestational diabetes and therefore also preeclampsia.

Women with kidney problems are choosing to stay pregnant, which makes them at a high risk of developing preeclampsia.

From 2018 to 2025 I estimate that I saw the high-risk patients go from being 60 per cent of the workload at RPA to 80 per cent of the workload.

Because there are so many high-risk patients I am in constant consultation with the multidisciplinary team…

These different patients require observations that are different to the standard observations, require a lot of different care and I am exposed to different outcomes for the babies because of risks for the mum.

Because of the high rate of high-risk and IVF women, there are more inductions of labour… [a]n induction increases the job of a RM tenfold compared to a spontaneous labour and puts the woman more at risk of needing instrumental intervention or a cesarean section, which also increases the RM’s workload.

I have acquired a significant number of additional skills since I completed university in 2018 but I have never been remunerated for having these.

*This is an excerpt from witness statements of one of our members who participated in the Special Case.

Rising acuity transforms nursing role

December 5, 2025 by lvo@nswnma.asn.au Leave a Comment

RN/M Kathryn Fifield is the facility manager of the multipurpose service in the southwestern NSW town of Henty. Her witness statement described the impact of increasing patient acuity on the MPS, which has 12 aged care beds, three acute beds and two ED beds.

In her witness statement, Kathryn outlined:

Five years ago I saw that the patients in the acute beds were sub-acute. These patients were likely a step up in assistance from home care, were waiting for an aged care bed or had a disease such as gastroenteritis.

Today I see that we are holding higher acuity patients including those with mild sepsis, congestive heart failure or renal failure. This has meant the workload at Henty MPS has also increased. Patients in the aged beds are people that can’t live at home and who need increased assistance.

Five years ago, I observed that we used to have low and high-acuity patients in the aged care beds. Today I observe that they are all high-acuity patients as chronic and complex conditions have increased across the board tenfold due to new medical interventions and people staying alive longer.

I have experienced that there is a higher level of medical intervention and we nurses are expected to care for these patients. This means nurses need to be upskilled and there is a requirement for further education for more complex interventions.

This has increased the knowledgebase people need as there are many more procedures and things people have now that nurses have had to learn to do.

I have seen a 50 per cent increase in the number of bariatric patients which are obese patients with a body mass index greater than 40… If you put two or three bariatric patients in a ward this is a lot of additional work.

An increase in bariatric patients increases safety fatigue and manual handling risks for staff. When I did a medication round in Deniliquin in the early 2000s I gave out half the medication I see that is given now… nurses now need to know a wide variety of medications [and] understand those and their interactions.

*This is an excerpt from witness statements of one of our members who participated in the Special Case.

Greater expectations on ED nurses

December 5, 2025 by lvo@nswnma.asn.au Leave a Comment

Julia Costello, a Nurse Practitioner at Port Macquarie Hospital, has worked continuously in emergency departments since she graduated in 2008. Her witness statement described the increased expectations on ED nurses to be able to de-escalate patients, recognise mental health issues and apply mental health first aid to patients experiencing grief, anxiety, depression or psychosis.

In her witness statement, Julia outlined:

Most emergency nurses I know have had some kind of physical thing happened to them, I’ve seen people punched in the face, I’ve seen someone attacked with an IV pole. I worked with a colleague who has a large scar on her face after sustaining a 10-centimetrecut on her forehead after she was assaulted by a patient.

I have been punched in the head multiple times. I have been kicked in the chest. I have been spat on. I have had people try and rip the skin off my arm.

There has however been an increase in training directed at assisting nurses to become more skilled in managing aggressive patient behaviour.

This training is excellent but it is once-only training, there is no follow up. I am expected to do the training and then retain the skills and knowledge forever.

I have seen in my own practice that the skill of communicating with and de-escalating aggressive patients is a skill that comes with time and experience. It isn’t something that can be simply taught in a once-off training session. It is something that I have learned through practice and role modelling over many years.

In this way, managing aggressive patients went from being a difficult part of my job to an expectation that I will participate in these kind of situations because nurses now have received explicit training, it becomes an expectation that training will be used to de-escalate violent and or aggressive patients in EDs.

Aggressive patients used to be managed via a physical restraint. Now this is only done until the patient can be chemically sedated and is only done so the chemical sedation can be administered in away that is safe for the health staff administering the chemical restraint and the patient.

*This is a excerpt from witness statements of one of our members who participated in the Special Case.