The Lamp August 2014

+Print Post Approved: PP100007890

lampTHE MAGAZINE OF THE NSW NURSES AND MIDWIVES’ ASSOCIATION

VOLUME 71 No.7 AUGUST 2014

Nurses andmidwives say hands off Medicare!

AGED CARE FACILITIES AT RISK STOP BULLYING AT WORKSTAND UP AND BE COUNTED

vices chooserMore people i

A for their se HESTTAn health and comm

supermunity

und‘Super Fu

ear’d of the Ye

our super fYYo

und can make a lifetime

e of difference

hesta.com.au

A history of strong returns

Low fees

Run only to benefit members

A products.ch should be considered when making a decision about HESTast performance is not a reliable indicator of future performance.p or down. P

A) ABN 64 971 749 321. Product ratings are only one factorst Australia (HEST

or more information, Fto be considered when

. Australia Ltd AH.E.S.TT.

for ahesta.com.aucall 1800 813 327 or visit hesta.com.au/ratings making a decision. See

ruBN 66 006 818 695 AFSL No. 235249, the T

a copy of a Product Disclosure Statement whic for more information. Investments may go ups

russtee of Health Employees Superannuation T

REGULARS

5 Editorial 6 Your letters8 News in brief33 Ask Judith37 Social media41 Crossword43 Nursing research online45 Books46 Movies of the month50 Diary dates

22 | Nursing home changes on hold

12 | Bust the budget

Tony Abbott is no doubt hoping that communityanger towards his first budget will subside withthe passing of time. A turnout of 15,000 atthe Bust the Budget rally in Sydney suggestsotherwise.

Take to social media andoppose the budget cuts.

Kerry Rodgers NUMPHOTOGRAPH: TIM DALBY

16 | Stand up and be counted

Australian unions are the difference between aneconomy with decent wagesand an American one wherethe low paid miss out,according to Nobel Prizewinner Joseph Stiglitz.

18 | Nobel prize winner saysMedicare changes “absurd”

There was an unexpectedattendee at a recentmeeting to discussprivatisation of the newNorthern Beaches Hospital— NSW Premier Mike Baird.

20 | A clash of visions

THE LAMP AUGUST 2014 | 3

CONTENTS

COVER STORY

COVER STORYAGED CARE

6 | Give away:Five pairs of MBT shoes

COMPETITION NORTHERN BEACHES

COVER STORY

CONTACTS

NSW Nurses and Midwives’ AssociationFor all membership enquiries and assistance,including Lamp subscriptions and change of address,contact our Sydney office.

Sydney Office50 O’Dea Avenue, Waterloo NSW 2017(all correspondence)T 8595 1234 (metro) 1300 367 962 (non-metro)F 9662 1414 E [email protected] www.nswnma.asn.au

Hunter Office8-14 Telford Street, Newcastle East NSW 2300

NSWNMA Communications ManagerJanaki Chellam-Rajendra T 8595 1258

For all editorial enquiries letters and diary datesT 8595 1234 E [email protected] 50 O’Dea Avenue, Waterloo NSW 2017

Produced byHester Communications T 9568 3148

Press ReleasesSend your press releases to:F 9662 1414 E [email protected]

Editorial Committee• Brett Holmes, NSWNMA General Secretary• Judith Kiejda, NSWNMA Assistant General Secretary• Coral Levett, NSWNMA President• Peg Hibbert, Hornsby & Ku-Ring-Gai Hospital• Michelle Cashman, Long Jetty Continuing Care• Richard Noort, Justice Health

AdvertisingPatricia PurcellT 8595 2139 or 0416 259 845 or F 9662 1414E [email protected]

Information and Records Management CentreTo find old articles from The Lamp, or to borrow from the NSWNMA nursing and health collection, contact:Jeannette Bromfield, CoordinatorT 8595 2175 E [email protected] Lamp ISSN: 0047-3936

General disclaimerThe Lamp is the official magazine of the NSWNMA.Views expressed in articles are contributors’ own andnot necessarily those of the NSWNMA. Statements offact are believed to be true, but no legal responsibilityis accepted for them. All material appearing in TheLamp is covered by copyright and may not bereproduced without prior written permission. TheNSWNMA takes no responsibility for the advertisingappearing herein and it does not necessarily endorseany products advertised.

PrivacyPrivacy statement: The NSWNMA collects personalinformation from members in order to perform our roleof representing their industrial and professionalinterests. We place great emphasis on maintaining andenhancing the privacy and security of your personalinformation. Personal information is protected underlaw and can only be released to someone else wherethe law requires or where you give permission. If youhave concerns about your personal information pleasecontact the NSWNMA office. If you are still not satisfiedthat your privacy is being maintained you can contactthe Privacy Commission.

Subscriptions for 2014Free to all Association members. Professional memberscan subscribe to the magazine at a reduced rate of $55.Individuals $80, Institutions $135, Overseas $145.

lampTHE

VOLUME 71 No.7 AUGUST 2014

NURSWMID

IT’S I

SES ANDWIVES:

ANTMPORTTA

ou

IT’S IO NT

YYo

FINME

t be a

ANTMPORTTATENO

mus

NANCIALMBER

L

MEof thand o entAll»A

MBERW Nurshe NS

es’ AsMidwivour ene ynsur

tionsocia Asid t J

sestionsocias

ontitlement tes servic

I

o:

All theailabva

cA»oPr»

Ins

e ones arese servico members wble t

cident Journcsional Indesof

.eancsur

nlyewho ar

eancy Insurnedemnity

e

ailabfinanciva

fi iour my

chwitsect Dir

o members wial members. Makble ti l b M k

emamembership roll dyrom paing fr

Debit.

ee

who are sur

yins financial bodeductions t

IT’S EARing a

5 19851300 3

wnlDoour Dy

Y!SAy oodand check t

) oro234 (metral).7 962 (rur36

e anompletoad, corm tect Debit fDir

on

eturnnd rtionsociao the Ast

n.

When he was the Treasurer and Minister forIndustrial Relations, new Premier, Mike Bairdpromised nurses and midwives a 2.5% payincrease. It was a sum members were prepared toaccept, when improvements to nurse-to-patientratios were on the table, in negotiations with theprevious Labor administration.Since then the Liberal government has pulledout all the stops to avoid paying even thatmodest increase in full, let alone acknowledgingour claim for improved nurse-to-patient ratios. First, it tried to reduce the 2.5% to 2.25% andget public sector workers to pay for the 0.25%increase in the superannuation guaranteelegislated by federal government. Following a union challenge, the NSWIndustrial Relations Commission reinstated thefull 2.5% pay increase to public sector workers,including nurses and midwives, in June last year.Subsequently, the government has resorted to asuccession of legal challenges, regulations andlegislation to get its way. In the process it hastreated with disdain the IR Commission,parliament and not least, the views of nurses and midwives.Now, after a derisory process, which confirmsthat good faith bargaining is dead in NSW, the Ministry of Health has applied to vary thePublic Health System Nurses’ and Midwives’ Awardto increase wages and salary-related allowancesby 2.27% from 1 July 2014. In his public appearances Premier Baird isassiduous in displaying sincerity; at a recentmeeting of the Northern Beaches CommunityUnions Alliance he claimed that he “believe[d]in looking after nurses” (see page 20).One has to question this when you put theactions of the Premier and his governmentunder the microscope.On pay and conditions: if you wantimprovements beyond the 2.5% (minus superincreases) you will have to trade off existingconditions. If you want to improve and extendratios to improve patient safety then the

government expects nurses and midwives to payfor it through trade offs.The Premier is undoubtedly sincere in hiscommitment to private sector involvement inrunning public hospitals. What does this meanfor nurses and midwives working in publichospitals like Manly and Mona Vale that areabout to be privatised? At the Dee Why meetingthe Premier said “there are protections there,there are opportunities and no one will beforced to do anything”.What he failed to mention was that the wagesand conditions of nurses and midwives are onlyprotected for the first two years of the newprivate operator’s 20-year contract. He also failedto mention what would be the fate of hard-fought for ratios in those hospitals. It is hard to see, within the pattern of publichealth policies emanating from state and federalLiberal governments, any empathy for nurses andmidwives working in the public health system.Privatising public hospitals, outsourcing palliativeand mental health services, co-payments for GPvisits, massive cuts to future state public healthfunding and cuts to preventative health programsare just some of the attacks that have raineddown on the public health system, its nurses andmidwives and Medicare, from Prime MinisterTony Abbott and Premier Mike Baird over thepast few months.The Abbott and Baird governments have beenequally intransigent on these issues. They havenot shown any willingness to listen to nurses andmidwives, who live the experience of the publichealth system daily.But in eight months we will have a state electionand nurses and midwives will have a chance tohave their say on how they judge thegovernment’s approach to the public healthsystem that we know the community cherishes. Our job is to tell it how we see it, havinglistened to our members and with the benefit ofthe larger picture of the global forces that aredriving conservative governments.


BY BRETT HOLMES GENERAL SECRETARY

EDITORIAL

“It is hard to see,within thepattern ofpublic healthpoliciesemanatingfrom state andfederal Liberalgovernments,any empathyfor nurses andmidwivesworking in the publichealth system.”

Baird to public sector nurses andmidwives: take or leave your 2.27%New South Wales has a new Premier but the modus operandi remainsthe same. The state government has again unilaterally imposed its willon public sector pay and conditions.

YOUR LETTERS

LETTER OF THE MONTH

Every letterpublishedreceives a$20 ColesGroup & Myergift card.

letter of the

month

unionshopper.com.au • 1300 368 117

The letter judged the best each month will be awarded a $50 Coles Myer voucher.

“Whatever your next purchase, remember Union Shopper.After all, who can think of a reason NOT to save.”

HAVEYOURSAYSend your letters to: Editorial Enquiries email [email protected] fax 9662 1414 mail 50 O’Dea Avenue, Waterloo NSW 2017. Please include a high resolution photo along with your name, address, phone and membership number. Letters may be edited for clarity and space. Anonymous letters will not be published.

Why disenfranchisethe vulnerable?I have many concerns about this budget. I’m concerned about elderly people with chronic healthissues whose only income is the pension, after being manualworkers all their lives, who now are worried about choicesthey may need to make about which medications to buyand when they can afford to see their GP and specialists.I’m concerned, as a nurse in a small country multi-purposecentre with emergency and outpatient departments, aboutcollecting monies from patients out of hours – we don’thave security personnel or admin assistants out of normaloffice hours or on weekends.I’m also concerned about having to inform a family after apresentation that they will be sent an account for servicesrendered by the health system.My general concerns: the rich remain healthy while thepoor live in financial worry about what they will do if they become unwell. It is not inconceivable that familiesmay find themselves in a position where they have tochoose which of their members is most unwell and the one to be treated. It is very hard for me to get my head around the fact thatin this day and age our elected leaders are actively choosingto disenfranchise those who are vulnerable in our society.Bernadette Proctor RN, Ganmain

COMPETITION

foyt ro suppotned gesiD

y!aall dou -

eso

ou y shoe yne pairs and

ed tente paess es strevneds desig

eet ffeour ye on rou aywhen

e pairs ofivF”ajaarT “FMB

k shoorblack wy!awe ao givt

e unlike anT shoes art MBt thaonfidene so ce arWy fivawe aivo gt tane wt w, thaeorn before wvha

he paTy about them. o sae tvou hat ythen hear whaelieve and rour gait and postures yvon imprdesig

ned e shoes desighese arT. nees and back, k, hipsleson ank.yeet all daessional who is on their fofor the prf

en a pair of ivor and ged f, fittedte people will be selecivFt d a’’dhose people will then be videoT. k shoesorw””ajaar“F

he T. ts on the shoese their thoughivo gth tthe end of a mon.videos will be used online

, our namee yit, simply wre pairsor one of the fivo apply fTToess and membership number on the back of an addr

o:elope and send tvenetitionompT CMB

, 2017, NSWW,oo,loertaW, enuev’Dea A50 Oompetition opens . CA members onlyom NSWNMies frompetition entrC

wn on 1st of the e is draizhe prTugust 2014. ugust 2014 and closes 31 A1 Aor an unclaimeded ffoequirw is redraf a rwing the competition. Iollomonth ffo

. NSW ew datinal draigom the oro 3 months fre it must be held up tizprM/14/00042.TPmit no: LLTper

YOUR LETTERS

Concerned by budget cutsThese federal budget cuts are veryconcerning. We are already told, find ways to cut inour department or else admin will doit. University fees are already expensivefor nurses. Is Medicare really underthreat? The health funds are very

unsatisfactory and you pay enormously if you use yourfund. What on earth are sick people who can’t workgoing to do? Doctors will stop doing expensive testsunless health funds can cover them. Workloads! We only just got there. Now we will beforced to do more again, putting patient care at risk.I am really worried for my patients and the resources I will not have to care for them.Katy Hunt RN, Maroubra

Prison closures lead to job lossesRe the push to re-open KirkconnellCorrectional Centre: I received aphone call from a prison officer wholost his job at Grafton due to theclosure of the prison up in that area. I lost my job as a nurse and received aredundancy when Kirkconnell

Correctional Centre closed [in 2011]. It resulted in theloss of more than 50 local jobs and more than $5 millionfrom the local economies of Lithgow and Bathurst. At the time I presented a petition to the NSWParliament with more than 1000 signatures, requestingthat the decision be reversed and lobbied our localmember Paul Toole to keep the prison open, which didnot happen. I did manage to save a few jobs by having officersrelocated to positions at Bathurst and Lithgow. I attended the Prison Closure Inquiryat Grafton and represented myself and other staffmembers affected by the Kirkconnell closure. The NSWUpper House inquiry, which I also lobbied hard for,found NSW Corrective Services failed in their duty ofcare towards rural and local small businesses by theirfailure to consider a rural and economic impact statementbefore making any decision to close prisons in countryareas.I wish to remind people that the Lithgow Prison wasestablished by the then Greiner government in the 1990s,due to the oppressed Lithgow economy of the day. I recently raised concerns on WIN News about anincreasing prison population and possible overcrowding atLithgow Correctional Centre, with the increase of bednumbers from 328 to well over 400 today. The prisonpopulation currently is close to 11,000 and if trendscontinue will reach 12,500 by March 2015, according toNSW Bureau of Crime Statistics. The Kirkconnell centre has been mothballed since 2011and is costing thousands of dollars a year in security. Anthony Craig RN, Lithgow

Problem doesn’t lie with 457 visa holdersI am working as a practice nurse in New SouthWales. I received a copy of your magazine and had aglance through. Firstly, I appreciate your efforts tostand for the common people and nurses’ interestsand welfare. But I read an article in The Lampregarding the issue of 457 visa holder nurses vs.graduate nurses and I want to address the issue from

the point of view of a (former) 457 visa-holder.The article states that because of employers taking overseas nurses with457 visas, graduates are not getting jobs.I came to Australia after getting a 457 visa and had a lot of expenses tocome here; courses to attain AHPRA registration, including thelanguage requirements, as well as accommodation and travel.When we were overseas, we were told it was favourable here for workand study and that is why we came. What I am trying to say is this:Australian registration is not free for us. We had to undergo a lot of stressand financial difficulties and at the end, not everyone gets a job hereeither. Employers usually sponsor 457 employees for permanentresidency (PR) and in return they have to work for the employer fortwo more years.Now let’s see the graduates’ problem. It is not pleasant to watch whilethey are not getting jobs and someone else gets it. Why is no one trying to put an end to such courses and studyrequirements here so that no one can come from overseas to snatchtheir jobs? I think nothing will happen because the institutions don’twant to stop their source of money from overseas. I reacted to this issue because I know many Association members have457 visas. Many times I’ve heard talk that we are here to snatch the jobs of poorgraduates. Why is no one concerned about hiring overseas nurses fromcountries like Ireland and the UK? They have jobs, registration andexperience there but the employers and institutions are hiring themdirectly too with PR status. The Lamp author didn’t seem aware of such migration and job losses but only saw the problems with 457 visa holders. Treesa Issac RN, Lake Heights

NSWNMA respondsThe NSWNMA is sorry if you felt that 457 visa holders had been singledout for criticism in relation to the inability of graduate nurses to obtainpositions.We appreciate the difficulties that many current nurses on 457 visas haveexperienced, both in terms of cost and increased stress.In 2012 Public Services International carried out an investigation, whichthe NSWNMA and the Queensland Nurses Union participated in, togain an understanding of the issues facing nurses as 457 visa holders. Thefinal report highlighted the concerns you raise, among others, and resulted ina number of recommendations.As part of our response to a federal Department of Immigration and BorderProtection consultation into the 457 visa program, we provided a copy of thePSI report and highlighted these concerns and recommendations. There needsto be increased regulation of the migration of nurses and midwives and theNSWNMA remains committed to that. Not only so that graduate nursesare able to obtain positions, but also so nurses and midwives employed on457 visas receive equal and equitable access to work, education and socialsupport.Thank you for writing – it helps to have direct feedback.


8 | THE LAMP AUGUST 2014

NEWS IN BRIEF

United Kingdom

British nurses consider strike over payHundreds of thousands of NHS workers, including nursesand midwives, are considering strike action in a disputeover pay. The Guardian reports that health union Unison said it would ask 300,000 of its members to back walkouts following thegovernment’s decision not to accept a recommended across-the-board 1 per cent wage rise for NHS staff.If approved the industrial action will take place in early October,followed by further waves of strike action.The strike would involve nurses, therapists, porters, paramedics,medical secretaries, cooks, cleaners and healthcare assistants.Unison said the government’s decision not to implement the 1 per cent pay rise recommended by the NHS pay review bodywould deny 60% of NHS staff and 70% of nurses a pay rise forthe next two years.Christina McAnea, head of health at Unison, told The Guardian:“Balloting for strike action is not an easy decision – especially inthe NHS. But this government is showing complete contempt forNHS workers.“It has swept aside the pay review body’s recommendations andignored the union’s call for a fair deal. Our members are angry atthe way they are being treated and we are left with little choicebut to ballot for action.“We hope to work closely with the other health unions to planand coordinate action. It is not too late however for [the healthsecretary] Jeremy Hunt to agree to further talks, withoutpreconditions, to settle the dispute.”The ballot will begin on 28 August and run until 18 September.The Royal College of Midwives (RCM) said it would also ballotits members on whether or not to take industrial action.

“BALLOTING FORSTRIKE ACTIONIS NOT AN EASYDECISION —ESPECIALLY IN THE NHS.”— Christina McAnea

Australia

Happy winnerSarah Talamayan RN was the happy winner of an iPadmini after completing Have Your Say, an importantsurvey for the NSWNMA to find out exactly what’s onmembers’ minds about their future.

To advertise please contact Patricia Purcell02 8595 2139 // 0416 259 845 // [email protected]

ADVERTISE IN THE LAMP. REACH OVER60,000 NURSES AND MIDWIVES.

NEW! Library

catalogue now online!


NEWS IN BRIEF

Australia

Government criticised for treatment of detainedchildrenThe federal government’s medicalhealth provider – International Healthand Medical Service (IHMS) – hasbeen widely criticised for itstreatment of children living indetention centres across Australiaand in offshore processing centres inNauru and Papua New Guinea.According to the president of theAustralian Human Rights Commissionchildren with serious medical issues indetention camps are being given grosslyinadequate treatment.“The evidence we have suggests thedelivery of medical services is poor andwith all sorts of problems,” said ProfessorGillian Triggs. “The mantra appears to be‘take a Panadol and have a rest’.” In May it was revealed there is no full-timeIHMS psychiatrist on Manus Island, despiteclinical assessments by IHMS that foundabout half the asylum seekers in detentionon Manus Island and Nauru are sufferingfrom significant depression, stress oranxiety.Immigration Minister Scott Morrison hadpreviously assured human rights groupsthat there was a psychiatrist on the island.

NEWS IN BRIEF

United States

Health records hacked The hacking of people’s health records isescalating in the fragmented and privatised UShealth system according to security experts.According to experts interviewed by the online newssite POLITICO thieves see patient records in avulnerable health care system as an attractive target.On the black market a full identity profile containedin a single health record can fetch as much as $US500.The Identify Theft Resource Center, which identified353 breaches in 2014, said almost half of thoseoccurred in the health sector. Criminal attacks onhealth data have doubled since 2000 according to thePonemon Institute, an industry leader in data security.1.84 million people have been victims of medicalidentity theft according to a Ponemon report releasedlast year, including 313,000 victims in 2013, a 19 percent jump on the previous year.The out-of-pocket costs incurred by victims ofmedical identity theft averaged more than $18,000.Since the US Department of Health and HumanServices began tracking the numbers in 2009 morethan 31.6 million individuals – roughly one in 10people in the US – have had their medical recordsexposed through some sort of hack, theft orunauthorised disclosure.

photo: chilout.org

“THE EVIDENCE THAT WE HAVETHAT SUGGESTS THEDELIVERY OF MEDICALSERVICES IS POOR AND WITHALL SORTS OF PROBLEMS.”

NEWS IN BRIEF


Australia

Profiting from your healthScreen jockeys in financial markets are licking theirlips in anticipation of money to be made inAustralia’s private hospital sector.An initial public offering of shares in Healthscope Ltd,Australia’s second-largest private hospital operator, isexpected to raise as much as $2.57 billion, making it thecountry’s third largest ever listing.The planned listing underlines the growing appeal toinvestors of the healthcare sector in Australia, wheregovernments at the state and federal level are looking toincrease private participation in health.The newly-listed company will have a market valuation ofbetween $3.33 billion and $3.81 billion. Managing director Robert Cooke told Reuters thecompany is planning to invest around $274 million inbuilding new private hospitals between 2015 and 2017.The number of Australians with private health insurance –the biggest driver of private hospital revenue – has risenfrom 9.8 million to 11 million since 2009, just under halfthe population. The Commonwealth pays an up to 30 percent rebate on private health insurance premiums.

Australia

New laws threaten penalty ratesLegislation before the federal parliament will stripcurrent protections around individual flexibilityagreements (IFAs) and make it much easier foremployers to force workers to forgo penalty rates,says the ACTU. “Hundreds of thousands of workers could be moved offsafety net conditions onto IFAs with less pay and lessconditions under a scheme that will make it virtuallyimpossible for workers to recoup their losses,” said ACTUsecretary Dave Oliver.He says the proposed new laws contradict Tony Abbott’s pre-election promise that workers would benefit or, at leastnot be worse off, under his government.“That was an outright lie. Mr Abbott is attacking theworkplace rights of hardworking Australians includingpenalty rates, the minimum wage and imposing unfairindividual contracts. “History tells us that, under WorkChoices individualcontracts cut penalty rates for an estimated 65 per cent ofsigned up workers, nearly 70 per cent lost annual leave andshift loading, half lost overtime and allowances and a quarterlost out on state and territory public holidays.“This new plan will see workers working longer for less payand outrageously includes a provision that requires them tosign away their future right to claim that the IFA left themworse off.”The ACTU believes the use of IFAs to remove awardentitlements will be most prevalent in low-paid industriessuch as aged care, cleaning, retail, hospitality, and disabilitysectors, where workers are highly dependent on the awardsafety net.

Australia

Richest 1% own same as poorest 60%The richest 1 per cent of Australians now owns the sameamount of wealth as the bottom 60 per cent, according toa new report by Oxfam Australia.The report also revealed that the country’s nine richestindividuals had a net worth of US$54.8 billion, more than thecombined bottom 20 per cent of the population, or 4.54million people.“Income inequality in Australia has been on the rise since themid-1990s, despite all sections of Australian societyexperiencing some increase in income during the sameperiod,” the report said.“In 1995, Australia had an average level of inequalitycompared to other wealthy OECD member countries. Today weare below average, having become less equal than our peersdespite having a better-performing economy than most.”A poll of 1016 people across Australia found that 79 per centof people felt the gap between the rich and the poor hadwidened over the past decade “and the majority of thosepeople said that’s made Australia a worse place to live”.Oxfam Australia’s chief executive, Helen Szoke, told The Guardian that Australia should use its role as the host of November’s G20 meeting in Brisbane to put inequality onthe agenda.“It’s about what role Australia can play in ensuring that gapdoesn’t grow so big that we have major problems globally inthe future,” she said.

“IT’S ABOUT WHATROLE AUSTRALIA CANPLAY IN ENSURINGTHAT GAP DOESN’TGROW SO BIG THATWE HAVE MAJORPROBLEMS GLOBALLYIN THE FUTURE.”— Helen Szoke, Oxfam Australia


NEWS IN BRIEF

To find out more, visit sydney.edu.au/nursing/next-level

TAKE YOUR CAREER TO THE NEXT LEVELSYDNEY NURSING SCHOOL PG EXPO 30 AUGUST 2014, 9AM – 4PMOur postgraduate courses equip you with the leadership, research and clinical expertise needed to advance your nursing career. Join us this August at our PG Expo or visit our website to explore your future.

14/4

125

.1 C

RIC

OS

00

026

A

Australia

Fruit, veg … and a health check Woolworths is trialling a scheme offering health checks to customers –and it has upset the Australian Medical Association and the PharmacyGuild of Australia.According to The Sydney Morning Herald nurses employed by the retailer have beenchecking blood pressure and cholesterol levels in customers across nine stores inNew South Wales and Queensland since October. The trial will be reviewed beforea decision on a full store rollout is made.AMA president Brian Owler told the SMH the healthcare system was “built ongeneral practice and highly qualified GPs leading primary care teams”. He said that with health delivered in a retail environment “there would be noaccess to patient history and no privacy.” Pharmacy Guild of Australia president George Tambassis told the ABC it was“hypocritical” for a supermarket that profits from selling tobacco and alcoholproducts to claim to be interested in healthcare.The Grattan Institute’s Dr Stephen Duckett says he sees the plan as a commercialresponse to the Coalition’s proposed $7 co-payment for GP visits.“People might be thinking of using Woolworths as an alternate source of advice toa GP,” he said.

United States

Right-wingers seeks to make union bargainingfees illegal An anti-union organisation financedby right wing billionairebusinessmen, the Koch brothers, isattempting to outlaw the agencyfees paid by non-union members tounions that bargain on their behalf. The case has been described as themost important labour law case theUS Supreme court has had to considerin decades.If the case is successful every state inthe US will essentially turn into ananti-union “right to work” state, whichwould be a significant blow to thecollective bargaining efforts of publicsector unions and would complicatethousands of existing contractsbetween organised workers andmunicipalities, cities, counties, andstates across the country.According to the Centre for MediaDemocracy’s PR Watch, the NationalRight to Work Legal DefenseFoundation, which has mounted thecase, was founded 60 years ago and“has been a national leader in theeffort to destroy public and privateunions”.The shadowy group, which along withtwo sister organisations has acombined revenue of $25 million ayear, also recently filed a law suit toblock workers in the VolkswagenChattanooga plant from voting forunion representation, and to preventVolkswagen from voluntarilyconsenting to any future organisingdrives.


COVER STORY

NURSES AND MIDWIVES JOINED WORKERSfrom other New South Wales unions andmembers of the public in a mass rally out-side Sydney Town Hall on Sunday 6 July,before flooding the streets of the CBD ina march to show opposition to the Abbottgovernment’s hostile attacks on Medicare,education and other social services.

Addressing the large crowd MarkLennon, secretary of Unions NSW, described the latest federal budget as morethan unfair.

“Not only is it unfair, it is deliberatelyunfair, because this is not just about thebudget, this is about a change of the agendafor this nation.

“This is about a change in the philo-sophical direction of the country.”

He said that while the Abbott govern-ment was “for the few” everyone “has aright to a job, a right to decent servicesincluding health and education and to adecent retirement income.

“Our health system is one that theworking people of this country paid forduring the [1983 Prices and Income] Accord, when they gave up decent wageincreases for a universal health system.”

Kerry Rodgers, a Nursing Unit Manager working in operating theatresspoke at the rally on behalf of theNSWNMA. She said changes to Medicareand cuts to health funding were “absolutemadness”.

“There is no funding crisis facingMedicare. A crisis has been manufacturedby the Abbott government and is drivenby Liberal ideology. Healthcare funding asa percentage of GDP is running at less thancomparable OECD countries,” Kerry said.

“When spending is expressed as a costper head of population our system is thesecond cheapest of comparable OECDcountries. Our health system delivers worldclass outcomes for patients.”

ACTU secretary Dave Oliver said thebudget was only the beginning of an attackby the Abbott government on the livingstandards of workers.

“Today we are not just coming outagainst Tony Abbott’s budget, we are coming out against the Americanisationof our society. Today we are defending theAustralian way of life,” he said.

“They also want to cut penalty ratesand reduce the minimum wage. There islegislation before parliament to bring backindividual agreements.”

Dave Oliver says the Royal Commissioninto unions shows Tony Abbott doesn’t likeunions because they have a proven track recordin opposing attacks on working people.

“That’s why he has a $60 million witchhunt against unions yet won’t lift a fingeragainst the Commonwealth Bank rippingoff people. Tony Abbott wants to take outthe union movement. I have news for youTony.This movement is here to stay.”


Bust the budgetTony Abbott is no doubt hoping that community angertowards his first budget will subside with the passingof time. A turnout of 15,000 at the Bust the Budget

rally in Sydney suggests otherwise.

“THERE IS NO FUNDINGCRISIS FACING MEDICARE. — Kerry Rodgers, NUM

Not long ago Kerry Rodgers confrontedthe treasurer Joe Hockey on ABC’s Q&A program, about the assault onhealth in his budget. She addressed theBust the Budget crowd on behalf of the NSWNMA.

“I’m here to represent 60,000 New SouthWales nurses and midwives, with theircollective voice, to defend our universalhealth care system, which is one of thebest in the world.

“Let’s be clear about two major issues: theAbbott government has no mandate forintroducing GP co-payments or forslashing the health budget.

“In the lead-up to the federal electionTony Abbott repeatedly stated there wasno threat to health, education orpensions. In doing so he unashamedlylied to the Australian public and hasshown he is not worthy to lead thiscountry.

“There is no funding crisis facingMedicare. A crisis has been manufacturedby the Abbott government and is drivenby Liberal ideology. Healthcare fundingas a percentage of GDP is running atless than comparable OECD countries.

“When spending is expressed as a costper head of population our system is thesecond cheapest of comparable OECDcountries. Our health system deliversworld class outcomes for patients.

“What is wrong with that equation?Nothing unless you are Tony Abbott, JoeHockey or Peter Dutton. The Liberalsbelieve we should have a user payssystem with the privatisation of servicesand where profits are put before patients.

“It is disgraceful. Not one study hasshown that the privatisation of servicesprovides better outcomes. In fact itdrives up prices and has been shown todeliver worse patient outcomes.

“Over the next four years New SouthWales hospital funding will be cut by$1.2 billion. Australian dental healthservices will be cut by $390 million.Preventative health programs will beslashed by more than $367 million. Theywill be dismantling Medicare Locals andprivatising those services.

“At the same time that billions are beingripped out of healthcare, Abbottcontinues to support huge taxconcessions for big business and major

banks, and continues measures such asthe diesel fuel subsidy that meanstaxpayers directly contribute to thebusiness costs of some of Australia’srichest people, such as Gina Rinehart.

“What does this mean for New SouthWales? Co-payments combined with theslashing of primary healthcare fundingare creating a perfect storm headed forour already overstretched, underresourced EDs, already facing a three percent increase in presentations accordingto the New South Wales government.

“For our poorest and most vulnerablepatients this means misery. There will belonger waits in ED and sicker patients as they have not been able to accesstimely care. If they need admission theremay not be a bed available due tofunding cuts.

“For staff there will be increasedworkloads and more frustration as theyare unable to deliver the care they knowthey should be giving.

“This is absolute madness.

“The only crisis facing Australia is themoral, ethical, compassionate bankruptcyof the Abbott government.”


COVER STORY

“NURSES ANDMIDWIVES SAY HANDS OFFMEDICARE!”— Kerry Rodgers NUMNepean Hospital

“THEY ARE TRYING TOPIT US AGAINST EACHOTHER.”— Maree O’Halloran NSW Welfare Rights Centre

“Our job is to help people who needto access the social security system –a system that has been built up so wedon’t have the rich living in fortressesand the poor living in ghettos.

“What this nation needs is not cuts towelfare but a job plan. But what dowe hear from the treasurer JoeHockey? That people [on socialsecurity] are taking money from theirneighbors. He is trying to break oursolidarity and pit us against each other.

“This budget would rip our socialprotection asunder. If the budget ispassed it will break the social securitynet for those who need it most.”


“STUDENTS GIVE THEBUDGET AN F FOR FAIL.”— Jade Tyrel, former presidentNational Union of Students

“This budget has breathed fire into thestudents of Australia. Their message forTony Abbott is ‘keep your hands off oureducation’. Our education is not forprofit and nor should it ever be. Wewant to put a big F for fail on TonyAbbott and Joe Hockey’s budget. Thebudget is a failure and a crime.

“If these changes get through, inequalitywill skyrocket. Education is a humanright and not a privilege and shouldalways be free.

“Students look at this budget and haveone thing to say ‘It shall not pass!’”

“I’M INCENSED BY THE WAY OLDERAUSTRALIANS HAVEBEEN DEMONISED!” — Lyn McIverFair Go For Pensioners

“The changes in the budget havedemonised those who can’t speak forthemselves. I’m incensed by the wayolder Australians have been demonised.Enough is enough Tony.

“We don’t have an economic crisis in thiscountry. What we’ve been told in themedia is lies and deception.

[Disability] can happen to anyone in life.Everything can change immediately andit can change the lives of everyone intheir circle.

“We can’t allow people to fall throughthe cracks and end up on the streets ofthis great city.”

THEAUSTRALIAN NURSINGAND MIDWIFERY FEDERATIONhas developed a set of social media tools so nurses andmidwives can have their say about the Abbott govern-ment’s budget changes, and lobby senators to stop thembecoming law.

Federal Secretary Lee Thomas says the ANMF hasdeveloped the tools to engage members and supportersin online political activity.

“This is focused on the new senate. We want thesenate to be under no illusion that the planned changesto Medicare and the introduction of the GP co-pay-ment are bad for health and bad for the community.We want the senate to vote against these changes andstop them becoming law,” she said.


COVER STORY

Take to socialmedia and opposethe budget cuts

“Hospitals will become overburdenedwith people who have not soughttreatment for a minor problem whichhas then developed into a major problem.People will die because they stoppedtheir medications or missed vitalpathology tests or did not get vaccinated.”

“I work with a very marginalised groupof mental health clients – it’s hardenough to have them attend a GP and[get] blood tests etc. The GP co-payment will make this exceedinglydifficult and in the end these clientswill suffer, as they will delay checkups etc.”

“As an aged pensioner on a very tightbudget, I would have to limit my visits

to the doctor and I would find theextra money for drugs also aburden. Sometimes my doctor refersme for scans, x-rays and ultrasoundsand that would really be too much and would mean less money spenton food or letting some bills gounpaid. This budget is so unfair.Please help us.”

“Health care is a basic right andno one should ever be afraid thatthey will be unable to affordtreatment. I am more than happyto pay taxes so that those whoneed a little assistance can get itwhen they need it.”

Nurses, midwives and supporters willhave a chance to nominate which budgetlie, budget cut or broken promise theywant to pledge against, such as cuts to thefederal health budget, the introduction ofGP co-payments, changes to family taxbenefits, changes to pensioner paymentsor university charges.

Once you make your pledge against these lies, cuts and broken promises, the website will allow you toautomatically promote your pledge to Facebook and Twitter using the hashtag,#healthcareemergency.

“We will make sure this is seen by decision makers, including key senators

and MPs,” Lee Thomas said. “We will bevisiting senators in Canberra, while yourbranch will be taking action to show senators that these lies, cuts and brokenpromises are not okay, that we did not votefor these cuts, and Tony Abbott and hisgovernment have no mandate to introducethese broken promises.

“This campaign is not simply going togo away, we must hold the government toaccount for the healthcare emergency theyare creating.

“Nurses and midwives must stand together against these terrible budgetchanges which are the beginning of theend for Medicare.”


Tell us what youthink of the budgetand healthThe 2014 federal budget has alarmedhealth workers across the country withits introduction of a GP co-paymentthat erodes the basis of Medicare,brings much higher fees for x-rays,scans and pathology tests, and makesmajor cuts to public hospital funding.

Visit www.nswnma.asn.au/our-budget-poll/ and tell us what you think in ourbudget poll. Here’s what some peoplehave already had to say:

“I am concerned that theenvironmental vandalism that formspart of this budget will impact onhealth for generations to come andbe irreversible.”

“I am concerned that scrappingthe CSIRO and creating a‘medical research fund’ is a wayof moving taxpayer dollars toprivate enterprise, and thatprivate enterprise doesn’tresearch with ‘common good’ inmind; they research with the aimof profiting, therefore illnesseswith less money-making potentialwill be ignored.”

“I work with very disenfranchisedyoung people who will forgo theirmedication or visiting their doctorso that they can afford to eat orpay their rent. I see elderly peopleevery day who need to see mycolleagues and I hear their storiesof working all their lives so thatthey can be healthy andindependent when they get older. Itrips my heart out that they alsohave to decide between affordingto eat, pay their utility bills or tocome and see their doctor and gettheir medication.”

• Pledge against a budget lie, cut or broken promise.• Promote your pledge to Facebook and Twitter using

#healthcareemergency.• Change your Facebook profile to fit the campaign.• Share the campaign with friends and family. • Donate money to a not-for-profit organisation that

has lost funding due to the budget cuts.

WHAT YOU CAN DO ON THE ANMF’S NEW WEBSITE

For more online resources to save Medicare go to http://www.nswnma.asn.au/get-involved/defending-medicare-and-public-health/

ON A RECENT VISIT TO AUSTRALIA PROFESSORStiglitz, who is Nobel laureate for economic sciences, nominated Australian budgetary changesto university fees and Medicare as the two biggestmistakes the Australian government could make,that would take it down the American path ofwidening inequality and economic stagnation.

Professor Stiglitz was asked by Fairfax Mediato nominate two mistakes he thought wouldmake Australia more like the US. He describedthe Abbott government plan to deregulate universities as “a crime” and the move to a GPco-payment “absurd”.

“Countries that imitate the American modelare kidding themselves,” he said. “It seems thatsome people here would like to emulate the American model. I don’t fully understand the logic.”

Professor Stiglitz says Australia has one of thebest healthcare systems in the world.

“Your outcome per dollar is probably the bestor one of the best. Your equality of access is oneof the best,” he said. “Why would anybody …try to make your system like the American system? The US is at the bottom.

“As for talk about a price signal, people don’tmake decisions about medical tests and proceduresbased on price. Maybe for cosmetic surgery they do,but for poor people, price signals price them out.”

UNIONS ARE DELIVERINGProfessor Stiglitz said that the American marketmodel had failed American workers, with infla-tion-adjusted income of a US household lowerthan it was 25 years ago, and the typical infla-tion-adjusted income of a male full-time workerits lowest in 40 years.

When Fairfax asked what Australia had doneright that the US had not, he replied: “unions”.

“You have been able to maintain strongertrade unions than the United States. The absenceof any protection for workers, any bargainingpower, has had adverse effects in the UnitedStates.

“You have a minimum wage of around $15an hour. We have a minimum wage of $8 an hour.That pulls down our entire wage structure.”


COVER STORY

Nobel prize winner saysMedicare changes “absurd”

Australian unions are the difference between an economy with decent wages and an American one where the low paid miss out,

according to Nobel Prize winner Joseph Stiglitz.

“WHY WOULD ANYBODY … TRYTO MAKE YOUR SYSTEM LIKETHE AMERICAN SYSTEM? THEU.S. IS AT THE BOTTOM.”— Professor Stiglitz


Health cutsthreaten AAA ratingThe influential ratings agencyStandard and Poors says the state’sAAA credit rating is under threatbecause of Abbott governmentbudget cuts, in particular to health.“We expect that the cuts couldcreate longer term pressure for thestate, in the absence ofcommensurate policy measures toincrease other funding sources ordampen growth in demand forservices,” the ratings agency said. According to the Australian FinancialReview NSW budget papers say thatcuts to federal grants programs,especially the National HospitalsFunding Agreement, would leave thestate $16 billion worse off per yearby 2050.

A Sydney University studysuggests the combined impactof higher co-payments will hitthose 65 and over the hardest. Apensioner couple will faceadditional out-of-pocket costsof $200 a year.

It found one-in-four adult visitsto a GP involved at least oneadditional pathology or imagingtest, meaning the minimumout-of-pocket cost for theconsultation would be $14.About 3 per cent of visitsinvolved both tests, or $21 inexpenses.

The full impact of the GP co-payment and changes to thePharmaceutical BenefitsScheme (PBS) would mean aself-funded, retired couplecould expect to pay, on average,an extra $244 a year in healthcosts, or $199 for a pensionercouple, according to the study.

The average patient with type 2 diabetes would face additionalbills of $120 a year regardless ofage, while families would pay$38 extra per child under 16.

A co-author of the study DrClare Bayram told the SydneyMorning Herald she was surprisedby the size of the financialimpact on pensioners.

“It really emphasises that it’s notgoing to be evenly distributed,”she said. “These people need touse the services, they’re notmaking a choice.”

Australian Medical Associationpresident Brian Owler said the study showed that GP co-payments had the greatestimpact on the most vulnerablein our society.

“It’s the sort of modelling thatreally should have been donebefore the proposal came out.”

Pensioners hardest hit by co-payments

Budget measure will lead to destitute young The federal government has allocated $230 million over four years toprovide emergency relief to those affected by a budget measure thatwill see jobseekers aged under 30 waiting six months beforebecoming eligible for unemployment benefits.

According to the Sydney Morning Herald the federal governmentexpects 550,000 applications for assistance, which will be delivered bycharities in the form of vouchers for food, transport or medications,parcels of food or household goods, clothing or by helping to pay rentor utility bills.

Department of Social Services deputy secretary Serena Wilsonadmitted in a senate hearing that there was a risk some of thoseaffected by the budget change would become homeless.

Maree O’Halloran, president of the National Welfare Rights Network,says youth unemployment will not be addressed by forcing youngpeople into destitution.

“The $230 million to be spent on emergency relief for those left withno safety net would be better spent providing 100,000 job seekerswith wage subsidy programs for four years,” she said.

BRETT HOLMES GENERALSECRETARY NSWNMA

“PRIVATISATION ALLOWSCOMPANIES TO MAKE A BUCK OUT OF PEOPLE’S MISERY.”“It is an honour to be able to tell the storythat we would like you to hear Premierand hear it loud and clear. The governmentmeans to close Manly hospital and downgrade services at Mona Vale to almostnothing and the bright new shiningFrenchs Forest hospital will be a privateentity. This move to private health is ultimately about dismantling our publichealth system which serves us well. It isabout private providers salivating at thethought of getting their hands on publicmoney to operate services and not have toput any of their money at risk.

Why would multi-billion dollar companies like Ramsay be interested inentering into the business of providingpublic health if there wasn’t a profit motiveinvolved? Make no mistake, this is aboutdismantling our universal health care sys-tem and putting profits before patients.

Our world class universal health systemis a major target for this government andwe are currently on the front line of defending it. Co-pays, or any form of userpays, are the slippery slope to a for-profitUS-style model and bait for profit drivencompanies like Ramsay and Healthscopeto enter the market and make a buck outof people’s misery.

Private hospitals want to expand their

market. By guaranteeing public beds in thenew Northern Beaches hospital the government is bankrolling the private sector. This way the private provider canaccess patients with private insurance atminimal start up cost.

Nobody wants a US-style health system– it doesn’t matter who you ask – yet bothour federal and state governments in theirideology, backed by the vicious federalbudget, are heading in that direction.

The NSW Nurses and Midwives’ Association is committed to stopping the

privatisation of the new Northern BeachesHospital and we’ve already been campaign-ing for months with our fellow unions inthis room and concerned communitygroups. We must stop this while we stillcan. If Campbell Newman can see senseand reverse the decision then Mike Bairdshould be able to as well.

I don’t think any of us, including thepremier, want a US-style health system.Premier, I invite you to defend our publichealth system and not let it go down thepath of a privatised system.”


PRIVATISATION

A clash of visionsThere was an unexpected attendee at a recent meeting to discuss

privatisation of the new Northern Beaches Hospital — NSW Premier MikeBaird. He did not make himself available to answer questions but he did

make clear his commitment to private involvement in the running of“public” hospitals. The well-attended meeting at Dee Why RSL wasorganised by the Northern Beaches Community Union Alliance. TheNSWNMA welcomes the support of the Alliance in keeping Northern

beaches hospitals public. Here’s what some of the participants had to say.

“NOBODYWANTS A US-STYLEHEALTHSYSTEM.”


LYN HOPPER RN“WHO IS MYEMPLOYER?”

“If this hospital is sopublic who is myemployer. Is myemployer Ramsay, thebiggest donor to theLiberal Party, orHealthscope? It is notgoing to be thepublic sector. It is notgoing to be theMinistry of Health. Ifthat’s my employer itmakes it a privatehospital in my book.”

Take actionat our pop upshopThe NSWNMA has set upa pop-up shop at 335Condamine Street inManly Vale. We will beholding a series ofactivities to inform thecommunity about thedangers of a privatisedsystem. To get involved [email protected]

NSW PREMIER MIKE BAIRD“I BELIEVE IN THE PRIVATESECTOR.”“I am not going to put forward any policythat I don’t strongly believe is in the long-term interests of the community.

I had many people come to me andsay we need a quality hospital and qualityfacilities on the Northern Beaches, includ-ing Lyn Hopper and I pay tribute to herfor standing alongside me to fight for this.

The question then comes down to themodel. It does make sense for a privatehospital to be here and we obviously needa new public hospital.

By sharing facilities in the middle – anemergency department, x-ray, operatingtheatres – there are great efficiencies thatcan go into better services and better fa-cilities. By having a management team thatmanages the private hospital, giving themcapacity to also manage the public hospital,we end up in a position where we’ve gota top level public hospital and, obviously, aprivate hospital next door.

Now, it is a public hospital. It’s exactlythe same if you turn up at Mona Vale or ifyou turn up at Manly. There’s no difference.The only difference is that it will be aworld-class facility.

I will support partnering with the pri-vate sector if we can deliver better facilities,improved services and great outcomes forthe community. That’s what I believe in.

I also believe in looking after ournurses, there are protections there, there

are opportunities, but no one will be forcedto do anything.

I understand the concerns you raiseand apologies if I haven’t got time to answer the questions today, but I can assureyou that the model we are putting forwardis in the community’s interest; it is part-nering with the private sector. Apologiesif not everyone here agrees.”

“I WILL SUPPORTPARTNERING WITHTHE PRIVATE SECTOR… THAT’S WHAT I BELIEVE IN.”

REGISTERED NURSES WILL REMAIN ONduty around the clock in nursing homesthroughout New South Wales – for now.

In June the Minister for Health JillianSkinner promised that the status quo wouldremain for 18 months while a “joint consultation process”, involving theNSWNMA, takes place.

Mrs Skinner said NSW Health wascommitted to providing all aged care residents with “a high level of care thataddresses their complex health needs”.

She said the consultation process aimedto reach “a consensus position for the wayforward”.

The NSWNMA raised the alarm overa proposed amendment to the NSW PublicHealth Act which aimed to remove the requirement for an RN to be employedaround the clock in care settings classifiedas nursing homes. These make up almosthalf of aged care facilities in NSW.

Employer organisations have called for“flexibility” in staffing and claim they arebest placed to decide when to roster RNs.

General Secretary of the NSWNMABrett Holmes says he is pleased Mrs Skin-ner has acknowledged the NSWNMA’sconcerns and ordered that the status quoremain – for the time being.

“Removal of the legislated require-ment, to have registered nurses on duty 24hours per day in aged care homes, is notin the best interests of residents,” Brett said.

“The Ministry of Health knows that un-well or injured aged care residents canoften end up in public hospital emergencydepartments and hospital beds.

“Having RNs in nursing homes canmake a significant difference as to whethera resident must be sent to hospital andwhen they can return.”

In NSW law the definition of a nursinghome relies on wording from the federalAged Care Act, which previously referredto “high care” and “low care”.

However the Act was recently changedto incorporate a new approach to bondsand payment systems and no longer distinguishes between high and low care.

According to NSWNMA Councilmember Debbie Lang RN, who has twoparents in residential care: “This changeeffectively makes the definition of a nursinghome in New South Wales redundant andundermines the staffing requirements associated with this.

“As well as this change affecting thestate Public Health Act, it also affects thePoisons and Therapeutic Goods Act, whichalso refers to the federal definition for nursing homes in describing who can handle different schedules of medicines,particularly in aged care.”

Debbie says it is up to the NSW government to decide to amend state lawto keep the current level of staffing

protection – and medication handling –or do nothing and let this go.

“If they walk away from the currentstate law they will be leaving it up to theproviders to staff how they wish.

“We must do all we can to protect thecurrent standards.”


AGED CARE

Nursing home changes on hold

A push to abolish the requirement to employ RNs around the clock in nursing homes has stalled.

“CHANGING THELAW ‘IS NOT INTHE BESTINTERESTS OFRESIDENTS’.” — Brett Holmes NSWNMAGeneral Secretary

“WE MUST DO ALL WE CAN TOPROTECT THECURRENTSTANDARDS.” — Debbie Lang RN

Mandatory RNs “wasteful” say providersThe Aged & Community Services Association of NSW & ACT has described therequirement to have an RN on duty at all times for high-care residents as “a waste of limited resources.”

The association represents not-for-profit providers operating 726 residential carefacilities throughout NSW and the ACT.

The association’s chief executive Illana Halliday told Australian Ageing Agenda recentlythat while skilled RNs were necessary in the provision of palliative care or short-termacute care in a facility, not all high care residents require an RN to meet their needs.

“It is probable that many residents with a high score in ACFI [Aged Care FundingInstrument] may still not need an RN, as the care they require is not acute orcurative, it is about comfort and quality of life,” Ms Halliday said.

A REGISTERED NURSE WHO TEACHESaged care says the push to remove RNsfrom nursing homes runs counter to current trends in nurse education.

Janet Langridge RN, who has workedat a number of aged care facilities, says tertiary institutions now offer post-graduatedegrees in aged care and dementia.

“This recognises that aged care is a specialty area that requires special skills,”she said. “On the other hand we haveproviders trying to have RNs removedfrom the floor.

“What should be occurring is the absolute reverse – lobbying for nurse practitioners in aged care.”

Janet teaches Certificate III in AgedCare at TAFE, which includes a medicationcomponent.

“The current curriculum is not aimedat training assistants in nursing to managecomplex care needs. Nor are there anymoves afoot to significantly alter the curriculum,” she said. “Certificate IIIcourses provide basic information on med-ication administration. However to admin-ister medication they need to be supervisedon site by an experienced nurse and givencompetency by that organisation to administer medication.

“I am concerned that, with someproviders becoming registered training organisations, there is a blurring of boundaries.

“There is real potential for policy errorsto be perpetuated throughout organi -sations, and for expediency to override safepractice when deciding how to staff facilities.

“I would be very concerned ifproviders … became solely responsible for the in-house training of high-level administration of medications.”

Janet says the move to get rid of RNsis a humanitarian failing because “it suggestsour elderly do not require trained profes-sionals taking care of their complex needs”.

“It is not just the aged. Due to the lackof suitable beds for young disabled peoplewe frequently have residents from the 18to 35 demographic.”

Janet says AiNs lack sufficient knowl-edge and skills to adequately manage arange of tasks including tracheostomies,catheterisations, morphine infusions, gastrostomy feeds, peritoneal dialysis, complex wound care and lymphoedemabandaging.

“What would happen after hours if acatheter blocks or an infusion needs replacing? The resident would be sent toaccident and emergency.

“This transfers the cost from the agedcare provider to the public health system.”

In other reactions from NSWNMAmembers a student nurse who works as anassistant in nursing, said she could notimagine an aged care facility operatingsafely without RNs.

MERRYN ANDERSON WORKS AS A CASUALAiN at a southern Sydney nursing homewhile studying for her nursing degree.

“I was very upset to hear that the requirement to have RNs in nursinghomes around the clock may be removed,”she said. “I understand it is about staffingflexibility in order to save money, becauseAiNs are cheaper. However I think the care provided would be unsafe for residents.”

Merryn said she had learned a lot aboutprocedures such as changing dressings, mo-bility, feeding and infection control whilebeing supervised by RNs at the nursinghome.

“The AiNs I work with are veryknowledgeable about aged care but theyrely on the RNs to do stuff which we arejust not qualified for.

“It would be a big worry for an AiNto have the responsibilities of an RN.”


Removing RNs a backward step

Skilled nursing care for the aged is essential, members say.

“THERE IS REALPOTENTIAL FOREXPEDIENCY …TO OVERRIDESAFE PRACTICE.”— Janet Langridge RN

“I THINK THECARE PROVIDEDWOULD BEUNSAFE FORRESIDENTS.” — Merryn Anderson AiN

IN A LETTER TO MINISTER FOR HEALTHJillian Skinner the Quality Aged Care Action Group (QACAG) said it was up tothe state government to maintain the roleof the RN as required by the NSW PublicHealth Act.

“Without action some 425 nursinghomes would be affected in New SouthWales and we are convinced that qualityof care would suffer,” said the president ofQACAG Margaret Zanghi.

“We do not believe it is enough to fallback on the [federal] Aged Care Act nor theassumed goodwill of providers to ensureregistered nurse cover in nursing homes.

“Many QACAG members have hadexperiences with care homes, and we havealready faced the consequences of poor

staffing for the care of our loved ones. “Many of us are shocked to find out

that, despite over 75 per cent of people inresidential aged care having high care needs– and therefore high level funding – if thefacility is not a nursing home there is norequirement for a registered nurse on dutyat all times.

“New South Wales has long protectedthe rights of frail older people to have a registered nurse on duty in a definednursing home, as a minimum.

“To lose this would open the way forlower registered nurse cover and relianceon less qualified staff despite the high levelneeds [and subsequently higher funding]of the people receiving nursing homecare.”


AGED CARE

425 aged

facilitiesat risk

An advocacy group hascalled on the state

government to keep thelaw that ensures a

registered nurse is onduty at all times in a

nursing home.

“WE DO NOTBELIEVE IT ISENOUGH TOFALL BACK ONTHE GOODWILLOF PROVIDERS TO ENSUREREGISTEREDNURSE COVERIN NURSINGHOMES.”

IN A BALLOT OF 50 NURSES AND OTHERemployees working at the Lady of Gracenursing home all but one approved a newthree-year agreement that includes annualpay increases of 3.25 per cent.

“Nurses are really pleased with the outcome and how smoothly the negotiations went,” Enrolled NursePauline Edwards, delegate of the facility’sNSWNMA branch said.

“We started by collecting ideas fromstaff about the sorts of improvements they wanted,” she said. “It took threemeetings with management to come toan agreement. Management initiallywanted a four-year agreement with annual increases of 2.7 per cent.”

Pauline says the agreement now pro-vides for full time employees who workSaturdays and Sundays to be paid fullpenalty rates for public holidays that fallon their days off.

The agreement provides for up to threedays paid union leave per year to allowNSWNMA members to attend confer-ences, courses and other union activities.

It also says management cannot makechanges to shifts without an employee’sagreement.

NSWNMA officials said negotiationsonly took three meetings – including amarathon final session – thanks to thecommitment of delegates and membersto reach agreement.

They said the employer’s agreementto paid leave for union business was arecognition of the “hard work and com-mitment” to the negotiation process andthe importance of effective delegates.

In other aged care news, nurses over-whelmingly approved a new three-yearenterprise agreement for the six high-care facilities operated by Scalabrini Vil-lage Ltd.

The agreement includes a 3 per centannual wage increase and improvementsto the classification structure to recognisediversity of nursing roles.

Improvements to classifications, training and the career path include:• Introduction of AiN Grade 2 for all

nurses with a Certificate IV in agedcare including a medication module

and second year undergraduatenurses.

• Creation of AiN/EN TransitionNurse Grade 3 to provide one-on-one care for new residents andfamilies with an emphasis onresidents with dementia.

• Team Leader Grade 4 to be open toGrade 2 AiNs and ENs and replacethe existing AiN Team Leaderallowance.

• Introduction of Nurse Educator –an EN responsible for some clinical

education of AiNs and ENs andmore general education.

• Quality Coordinator position to beopen to ENs as well as RNs.

• Certificate IV course costs to bepaid by Scalabrini.

• Minimum two hours pay whencalled in for mandatory training.Other features of the agreement in-

clude an increase in the casual loading to25 per cent. Casuals have a right to over-time after 38 hours in a week or 76 hoursin a fortnight.


Nurses back new agreementsNurses at the Lady of Grace nursing home

in the northern Sydney suburb of Dural have negotiated an improved agreement.

“NURSES ARE REALLY PLEASEDWITH THE OUTCOME AND HOWSMOOTHLY THE NEGOTIATIONSWENT.”— Pauline Edwards EN, delegate for the Lady of Grace nursing home NSWNMA branch

Front row left to right Mary Johns and Pauline Edwards. Back Row: Jessica Hearn and John Holmes


AGED CARE

“I WANT TO TEACH PEOPLETHAT PALLIATIVE CARE ISABOUT DOINGEVERYTHING FOR THATPERSON THAT ISFOCUSED ON COMFORTAND QUALITY.” — Jane Mahoney, CNC

MORE AND MORE PEOPLE REQUIRINGpalliative care are arriving in residentialaged care facilities. Yet according to theNational Aged Care Alliance, its avail-ability is the exception rather than thenorm.

“Ten to 15 years ago patients wouldhave remained in hospital until the endof their life,” palliative care CNC JaneMahoney told a recent NSWNMA forum for aged care nurses.

“Now residential aged care staff arebeing pulled and pushed in every direction because people are beingtrolleyed in, they are much sicker andwith higher needs. Our skills are beingtested all the time.”

Jane worked as a CNC for palliativecare in the South Western Sydney LocalHealth District for 15 years.

“I looked after people in the community who were palliative in theacute care hospitals, in private and public hospitals and in residential agedcare facilities.

“I think there was always a feelingdeep down in my soul that we reallyweren’t giving the residents in aged carefacilities a fair share of our palliativecare nurse consultancy. They came inright down the list, I’m ashamed to say.”

Since establishing her own businessin 2010, Palliative Aged Care Consul-tative Service, which provides clinicalconsultancy and education to aged carefacilities across New South Wales, herfeelings have been confirmed.

“Residents in aged care weren’t getting fair access to palliative care.”

Jane and a small team of specialistnurse consultants provide consults andassessments, symptom management, palliative care planning, facilitation ofcase conferencing, GP liaison, accredi-tation support, Aged Care Funding Instrument (ACFI) maximisation andeducation.

“We look at the quality of care we

give to people with a life threateningor life-ending illness. We encompasseveryone who is looking after that per-son or is a part of his or her life. Welook at all their symptoms, be theyphysical, psychological, emotional orspiritual.”

The World Health Organisation defines palliative care as improving thequality of life of patients and their fam-ilies facing the problems associated witha life threatening illness.

“Until you start working within thatarea you really don’t know how thattranslates,” Jane said. “Pain is a very obvious symptom we look for but Ithink other symptoms are equally im-portant, if not more so. Yet within thatACFI tool they only see pain as havingvalidity, which annoys me.

“You often have someone who has no pain, but may have intractable,dreadful nausea and that is a palliativecare emergency because having nausea24/7 is absolutely dreadful.

“We would look at and address pain,nausea, vomiting, loss of function, lossof movement, body imaging issues.”

Jane recommends assessment andre-assessment of residents and their levelof dependence and says often they cannot come to terms with their changing health status.

“Sometimes denial is a very ade-quate coping mechanism for many peo-ple. So it’s not about slapping them outof denial it’s about working with themand walking the journey with them.”

Often facilities have a culture ofsending people to hospital come theend of their lives. This might be becauseof lack of GP support, lack of staff, orlack of education.

“You can change that culture,knowing you have wonderful skills youcan apply, with the right support andthe right education and a bit of teachingto GPs,” she told the forum.

“It’s our role to be alert to what Icall the red flags of dying. Often theresident is showing signs of deteriora-tion and that is often a sign of themmoving toward the end of their life.

“We need to be aware and awaketo these and things like recurrent infections, recurrent UTIs, recurrentrespiratory tract infections, multiplecourses of antibiotics. Any change inswallowing should be a big red flag, asshould revolving hospital visits.

“If you send a resident to hospitalfor their breathing, they’ll be seen inED and ED will say ‘what the hell hasthe nursing home sent them here for?’They’ll say to the family ‘what do youexpect us to do, they’re dying don’t youknow?’ and they’ll send them back.

“If you have someone uncomfort-able and not getting quality treatmentwith their symptoms, you may have noalternative but to send them to hospital.But ask to speak to the senior nursingor med staff on that shift in ED, tellthem if they’re going to send them backthey require terminal medications tobe sent back with them.

“There’s a lot of talk about advancedcare directives and advanced care plan-ning and that definitely has a place. Butsometimes we’re in a situation wherewe can’t get an advanced care directivebecause the person is not in a positionto do that.

“So we’re talking with families andresidents about what the focus of careshould be, what is meaningful for youas a resident. That’s what palliative careis about and it’s a team approach.”

Too often, Jane says, the term palliative care is used in the sense of“there is nothing more we can do.”

“I want to teach people that pallia-tive care is about doing everything forthat person that is focused on comfortand quality. It’s just part of the fabric ofwhat we do in an aged care facility.”


Alert to the red flags of dying

Residents in aged care deserve fairer access to palliative care says clinical nurse consultant Jane Mahoney.

NSWNMA OFFICIALS HAVE HELD SEMINARSat eight locations across the state to explainnew anti-bullying laws to members.

The national laws, introduced by theprevious Labor government, took effecton January 1 this year and empower theFair Work Commission (FWC) to dealwith bullying in some workplaces. Thelaws apply to most aged care providers butnot state government organisations suchas NSW Health.

They are designed to allow workers af-fected by bullying to apply directly to theFWC for a fast hearing of their complaint.

The commission can order that bully-ing must stop and that an employer mustdevelop policy and provide training tocombat bullying, for example. Howeverthe commission cannot impose financialpenalties or order compensation.

NSWNMA Industrial Officer Katherine Rynne said bullying was defined

as unreasonable behaviour that creates arisk to health and safety, by causing anxiety, depression and stress, for example.

“Bullying covers a range of behaviourincluding – but not limited to – victimis-ing, humiliating, intimidating and threat-ening behaviour,” she told members at theParramatta seminar.

“It is not necessary to prove that harm

to health and safety has actually occurred.“Bullying has to have happened more

than once. It cannot be a one-off incident. “There must be a risk that the bullying

will continue because these laws are aimedat stopping future bullying. They are notaimed at punishment or compensation forpast bullying.”

Katherine said the laws apply to all


AGED CARE

Members working in aged care have heard how new national laws can help

Keep calm and stop bullying

“THESE LAWS ARE AIMED AT STOPPING FUTURE BULLYING. THEY ARE NOT AIMED AT PUNISHMENT OR COMPENSATION FOR PAST BULLYING.”

employees, including management, as wellas volunteers.

“Bullying does not include reasonablemanagement action carried out in a reasonable manner.

“For example, it is reasonable for anemployer to allocate work but probablynot reasonable to allocate one worker awhole lot more work than another worker.

“It is reasonable for managers to givefair and constructive feedback on a worker’sperformance.

“It is not reasonable, for example, togive someone a dressing down in the corridor in front of residents and otherworkers.

“If you work with someone with apersonal hygiene problem it is reasonableto take that person aside and have a conversation about it. It is not reasonableto hold your nose every time you walkpast them.”

NSWNMA organiser Lynette Flanaganpresented a case study of a recent bullyingcomplaint to the FWC. The case involvedan Association member who was beingbullied by another worker.

“Our member worked in a dementiaunit. Her co-worker would come into theunit when residents were settled and calmand deliberately disturb them to the pointof agitation. Then she would leave, whileour member struggled to resettle the residents,” Lynette said.

The member complained to manage-ment but management took no effectiveaction.

“The bully had a close relationship withmanagement,” Lynette said.

“Our member developed extreme anxiety and depression. She felt that noone was listening to her or believed herand that contributed to the breakdown ofher health.”

The member called the Association,which helped her complain to the FWC.

“FWC ordered mediation and thingsimproved for a while. But bullying startedagain so we went back to the commission.

“They called the employer in to explaintheir failure to address bullying. The employer was very clearly told they had totake action and the bullying stopped.”

Lynette, who previously worked as anaged care Assistant in Nursing, said it isnever too early to call the NSWNMA foradvice on bullying.

“It is wise to get us to help becausethere are a lot of forms to fill out,” shesaid.

“The complaint must come from oneor more individuals being bullied. We cannot make the complaint on your behalfbut we can advise you on how to dealwith the problem and help you lodge acomplaint.”


them deal with bullying.

at work

Are you being bullied?•Keep a written record of all bullying incidents including dates, times and witnesses.

•You must give your employer a chance to put a stop to the bullying before theFair Work Commission will accept your complaint. Follow your employer’s policyand procedures on bullying to lodge a complaint.

• If your employer does not have specific bullying policies and no clear protocols onhow to respond, call the NSWNMA for advice.

• If management fails to act on your complaint, or is unable to stop the bullying, youcan complain directly to the commission. The NSWNMA can help you lodge acomplaint.

•The commission must start to deal with your application within 14 days.

• It can arrange a mediation session involving an external mediator. If bullyingcontinues the case can go to a hearing where you may be required to giveevidence.

•The commission can issue orders against the employer as well as your co-workersand even visitors to the workplace.

• It can order the employer to put a stop to the bullying, monitor the employer’sconduct and direct the employer to provide information and support to staff.

What is bullying?Bullying at work is repeated unreasonable behaviour directed towards a worker or group of workers that creates a risk to health and safety. Examples include:

•Verbal abuse.

•Putting someone down.

•Spreading rumours or innuendo about someone.

• Interfering with someone’s personal property or work equipment.

•Deliberately excluding someone from workplace activities.

•Deliberately denying access to information or other resources.

•Withholding information that is vital for effective work performance.

•Deliberately changing work arrangements, such as rosters and leave, to inconvenience a particular worker or workers.

NURSES AT AUSTRALIA’S FIRST DEDICATEDwomen’s health centre were “incompe-tents” and “for the most part drunkenmen and in some cases drunken women”according to official documents.

They were employed to care for freewomen and convict residents at the Parra-matta Female Factory, itself a “source ofmoral corruption, insubordination and disease” according to Samuel Marsden, theFlogging Parson.

But while you might argue about themorals of its inmates and the quality of itsnursing care, there’s no doubt that todaythe factory is a big ticket historical item.

Which is why NSWNMA AssistantGeneral Secretary Judith Kiejda has urgedthe state government to support its nomi-nation for World Heritage listing.

“It is quite incredible that such an historic site could be at risk of private development,” Judith said. “The site is anintegral part of the early history of theAustralian settlement and particularly critical to the story of convict women’shistory in Australia.”

An estimated one in seven Australiansis said to be descended from 9000 femalefactory convicts, with more than 5000 ofthem coming from Parramatta.

“It’s a huge women’s story and it’s a

huge Australian story and that’s why wewant World Heritage,” historian and curator Gay Hendriksen, president of Parramatta Female Factory Friends, said.“The facts present quite a different pictureto the descriptions of degenerate womenwith little chance of reform.”

Literacy levels were close to that of immigrants at 75 per cent for the Englishwomen and 46 per cent for the Irish. Thewomen also brought more than 180 tradeswith them.

“That suggests laziness was not an inherent trait,” Gay said. Sixty five per centhad no prior convictions before transporta-tion. “This suggests the majority were notof the crime class.”

FIRST OF 12 FACTORIES The foundation stone for the ParramattaFemale Factory was laid in 1818 by Governor Lachlan Macquarie, who commissioned convict architect FrancisGreenway to design a factory to accom-modate 250 to 300 female convicts. It operated from 1821 to 1847 and replacedan earlier factory above the jail, where 200women worked but only 30 could be accommodated at night. By 1842, 1200women and 200 children were crammedinto the second factory.


HISTORY

Will our first women’s health centre survive?

The Parramatta FemaleFactory is a little knownand fascinating part ofSydney’s colonial history— and the NSWNMA issupporting its nominationfor World Heritage listing.

Parramatta Female Factory Entrance. photograph courtesy of ralph hawkins

For more information visit www.parramattafemalefactoryfriends.com.au or www.parragirls.org.au

Parramatta was the first of 12 morefemale factories and followed theestablishment of Hyde Park Barracks, alsodesigned by Greenway, which opened in1819 to accommodate 600 male convicts.

Yet despite their common history onlyHyde Park Barracks has UNESCO WorldHeritage listing under the title of AustralianConvict Sites, representing the bestsurviving examples of large-scale convicttransportation. These include The CascadesFemale Factory in Hobart built in 1828.

“In the Tasmanian female factorythere’s only a wall and a small cottage stillstanding,” Gay said. “We have the originalGreenway buildings and a whole lot moreand we predate all but three of the 11world-listed heritage convict sites.”

Parramatta was rejected from the initial2010 World Heritage listing because ofcustodianship concerns.

“The NSW government is thecustodian and they would have had toprovide the right level of custodianship foracceptance,” Gay said. “At the momentthere’s a big question mark over thatbecause they’re looking at developing thewhole of the heritage precinct of NorthParramatta. Our concern is what are theyplanning to do? Will the female factorysurvive?”

WOMEN OVERLOOKEDAt present the Greenway building on theCumberland Hospital site is being usedfor training, storage, offices, client consul-tation and a credit union.

Gay believes with listing it can be amoney-making educational and historicaltourist attraction like Port Arthur. “Thinkwhat a bonus it would be to have this inSydney.”

The 1837 Molesworth Inquiry intoconditions in female factories found that“society fixed the standard of the averagemoral excellence required of women muchhigher than that which it had erected formen … a higher degree of reformation isrequired in the case of a female, before society will concede to her that she hasreformed at all.”

To which some might mutter “Plus çachange.”

Gay thinks the female factor mightoriginally have been a reason for ignoringthe heritage value of the Parramatta factorywhile other convict sites were more publiclyacknowledged. “But now I think it’s reallythat it has been part of a governmentinstitution and in government hands for 190years and not had a public profile.”

She has been able to locate only fourimages of convict factory women from

1804 to 1856 when Parramatta wasoperating as a factory, and no cloth fromthe thousands of yards convict womenwould have produced there.

“You’ll see images of convict men andwe have images of women when they’veleft the factories and are in a familysituation. But for nearly half a centurythere was nothing, they were notconsidered important enough.”

WORLD HERITAGE 2015The Parramatta Female Factory Friendsare hoping the factory will be reconsideredfor World Heritage listing in 2015. Anotherorganisation made up of former residentsof the Parramatta Girls Home is seeking tohave the entire Parramatta FactoryPrecinct, including the factory, anorphanage, a mental asylum and a girls’home, declared Australia’s firstinternational Site of Conscience.

“We want to keep it simple so we’relooking at listing for the original footprintof the female factory hospital site only,”Gay said.

“We don’t know what thegovernment’s plans are. And we’re tryingto be positive and to advocate peacefully.But we will do what is necessary if there is risk.”


Augustus Earle (1793-1838). Female Penitentiary or Factory, Parramatta [circa 1826?]. rex nan kivell collection nk12/47. national library of australia.

RECNAA CR AEW SIHN TIL PICNUOCYAAY DLODIFFAD

tsugu2 Ay 2adirFua.moc.yadildoffad

FREE training for NSW Public Sector employees from non-English speaking backgrounds

Learn how to: • express ideas in meetings • build stronger relationships with clients and colleagues • produce more effective written correspondence • improve interview skills and career prospects

Learn online anytime, anywhere and receive support and feedback from experienced professionals

Trial one FREE unit from each course at http://ames.edu.au/

Click on Skillmax-Jobseekers Program then Public Sector Online-Skillmax to download an application form

Improve your Workplace Communication Skills Free English Courses – Public Sector Online

enurse..com.au

$3 $$3 $

$



ASK JUDITH When it comes to your rights andentitlements at work, NSWNMAAssistant General Secretary JUDITH KIEJDA has the answers.

Am I being punished?I am an RN working in the public system.Recently there have been complaints that I mademedication errors and I have been advised I willbe performance managed by the NUM and theCNE. I feel like I am being punished. Can myemployer do this?Yes, the employer is obligated to investigateand respond to clinical performance concernsunder the provisions of Policy DirectivePD2005-180 which states in part: “… Approaches to performance feedback: The focus of ‘managing for performance’should be on providing on-going and two-way feedback.For staff to learn and improve, feedbackshould be: objective; specific; constructive;focused on behaviours; free from the use ofnegative language and behaviours; andoccur as soon as possible after an event orkey milestone.”

The policy also states that performancemanagement “ … is most effective whenprovided in a supporting environment whichis based on learning and development.”

How much study leave?I am an RN working in the public sector andwould like to know how much study leave I amentitled to in a calendar year, as I would like toattend a conference interstate. My manager hasdenied my request and some of my colleagueshave advised me that I am entitled to five days.Is this correct?The amount of study leave per year is at thediscretion of the employer as per Clause 55,sub clause (iii), (a) and (b), of the Public HealthSystem Nurses’ and Midwives’ (State) Award(2011) .“(iii) ELIGIBILITY

(a)Access to learning and developmentleave is at the discretion of the Health

Service. It should be made available to alleligible employees within the HealthService to promote the development of ahighly trained, skilled and versatileworkforce, which is responsive to therequirements of government and healthservice delivery.(b) Permanent staff who are full-time orpart-time, and full-time temporaryemployees are eligible to apply for leave.Part-time temporary employees andpermanent part-time employees aregranted leave on a pro rata basis. Casualstaff are not eligible for this form of leave.”

When your manager refuses to grant therequested study leave they are required underthe Ministry of Health policy directive PD2006_066, part 7 “Eligibility”, to provide thefollowing advice:

“Where learning and development leave is notapproved, employers should ensure:

• Advice is timely to allow the staffmember to consider alternativearrangements;• the reason for non-approval of leave isclear and stated in writing to the staffmember;• the staff member is advised of theavailability of a review process.”

Long service blocked I am an EN who has worked at the same publichospital for 18 years. I know that I am entitled toLong Service Leave (LSL) but every time Irequest it I am told that I cannot go because thedepartment is too busy. Can my manager refuseto grant me LSL?LSL is arranged by mutual agreement betweenyou and your employer. Your employer’sobligations are to make sure that when youhave accrued the appropriate entitlement forLSL they don’t place any unnecessaryconstraints to prevent you taking it. If yourmanager cannot give you the leave at the time

you request, they should negotiate a timeframe with you that allows you to take therequested leave when it is suitable to bothparties. I refer you to the Ministry of Healthpolicy document, PD2006_092, section 12.

Single RDO not onI am employed in the public sector and rosteredto work 12-hour shifts. On the past five rosters Ihave been rostered off on single days. Aremanagement allowed to roster this way?No, the award does not provide for singlerostered days off when a 12-hour rosterprogram is in place. Clause 5, sub clause (v),(g) of the Public Health System Nurses’ andMidwives’ (State) Award (2011) states:“Employees shall not be rostered on singledays off unless it is at the request of theemployee.”

Time off to care for parentsI am an RN working in the public system. Both ofmy parents need to go into a hostel and I needsome time off to assist them with this transition.What type of leave should I ask for?In this circumstance you are entitled torequest Personal/Carer’s Leave, which isprovided under Clause 32, sub clause (xi) (b)of Part B Personal/Carer’s Leave of the PublicHealth System Nurses’ and Midwives’ (State)Award (2011). Personal/carer’s leave comes outof your sick leave and you can provide yourmanager with evidence for this leave such as adoctor’s certificate or a statutory declaration.The evidence supplied should include thename of the person requiring your care, whatrelationship they have to you and that theyhave a condition which requires your care orsupport. If you run out of sick leave you canelect to use any untaken annual leave or longservice leave as part of your personal/carer’sleave request.

THE VOICE OF LEADERSHIP — GET ALONG TO ETTALONG

Nursing & Midwifery Unit Managers Society of NSW Inc. Annual Conference

“The Voice of Leadership – Get Along to Ettalong”Friday 17 October 2014Ettalong Diggers, Ettalong BeachTo book please visit www.numsociety.org.au

Phone: 02 8970 0128 Email: [email protected] Web: www.numsociety.org.au


THOSE WERE THE DAYSB Y M A R Y P E R R Y

I t’s interesting how a bit of historical reflection – that’s new-speak for reminiscing – can make yourealise that life isn’t so bad after all.

Quite often one hears how “this wouldn’t have happened years ago…” or “things were better backwhen I was a student nurse…” or “PACE (MET) criteria charts take away a nurse’s need to think………………….…”

Anecdotes of drama, gore, and disasters were flying thick and fast at the reunion of my mum and hernursing colleagues. I called them “the old reunionites”– I went along for the ride (and the free feed)just to see if any of those tall tales I had heard over the years actually had a milligramme of truth inthem and could be verified. Especially the one about the politician – let’s call him the honourable MrEtho. The patient my mum said she will NEVER forget.

Scenario:The honourable Mr Etho was admitted to the surgical ward for a routine procedure – cholecystectomy.

He was given the only private room attached to the surgical pavilion ward. This was the room alwaysallocated to the wealthy or the dying – preference being in that order! It was situated at the farthestend of the ward so that noise emanating from the main area would not disturb the patient and privacywas optimal – just perfect for a famous politician wanting anonymity and probably post-operativemedicinal assistance provided by his associates.

The honourable Mr Etho was described by the “reunionites” as a charming, portly gentleman whoadmitted to “a bit too much of the good life” when he tipped the scales at 110 kg; his ruddy complexionand facial spider naevi supporting his comment.

Alarm bells should have started ringing right then – “Mum, grab the AWS chart stat!”“But darling, he was so polite, and he was a famous politician, and when I admitted him I was an

innocent 1st year nurse, and AWS charts hadn’t been invented.”Anyway, pre-op assessment was within acceptable limits so he was shaved, starved, wrapped up and

packed off to theatre.It was two days later that my mum was re-assigned to care for the honourable Mr Etho. In his secluded,

private room, the honourable Mr Etho was resting quietly – obs stable (although slight tachycardiapresent), tick; abdominal suture line intact, tick; T-tube drain (they were quite large back in thosedays) secured, patent and draining, tick; nasogastric tube secure and patent, tick; IV therapy runningto time, (no pumps back then), tick; mental status – mmmmm, a little bit agitated – probably justeverything catching up with him……………..

Mum then carried on with the usual busy morning activities out in the main ward and left thehonourable Mr Etho to recuperate.

“But mum, the ruddy complexion, the spider naevi and the ‘too much of the good life’”………………

The honourable Mr Etho was next checked about an hour later during which time he had managedto work himself up into a frenzied state of mania. And like a true politician he had the tenacity of aBull Mastiff protecting a 3 week old “maturing” chicken carcass – the growling jowls, gnashing teeth,and squinty eyes – definitely ’Mastifflike’.

The nurse call bell was way over the other side of the bed, and calling out was of no use owing to thegeographical setting of the room – just perfect for a famous politician wanting anonymity and probablypost-operative medicinal assistance provided by his associates.

What to do? Mum said it was the scariest moment of her career. Confronted by the honourable (now“Mastifflike”) Mr Etho with one fat leg stuck through the bedrails as he tried to escape, T-tube drain(they were quite large back in those days) being wrenched from its securing sutures, and IV line whichhad once been in his arm now being ripped out by his teeth. He hadn’t yet started on the nasogastrictube………

Mum couldn’t quite tell where most of the blood was coming from arm? abdominal region? or theenormous skin tear now developing on his leg as it sawed away on the bedrail.

The only way to get to the nurse call bell was to crawl under the bed while trying to avoid the poolsof blood – Mum said she felt like a soldier on bivouac training crawling through the mud; and at the

SHORT STORY AND POETRY COMPETITION


Find more stories at www.nswnma.asn.au/nswnmamembers/short-stories-and-poems-2014/

same time was wondering how long it would take for the cavalry to arrive. As she had indicated to herother colleagues on the shift that the honourable (now “Mastifflike”) Mr Etho was stable, albeit a littlebit cranky, her colleagues would not be on the alert for a pending disastrous situation.

Mum’s thoughts: stay calm…….., someone please, please, please answer the call bell; the honourable(now “Mastifflike”) Mr Etho please don’t fall on me, and please don’t bleed to death; should I startscreaming or will that make the honourable (now “Mastifflike” Mr Etho even more agitated??

Next thing mum knew, the honourable (now “Mastifflike”) Mr Etho had managed to pull the IV poleover landing on top of her legs as she crawled out from under the bed. Someone please, please, pleaseanswer the call bell now!!!

There was no stopping the honourable (now “Mastifflike”) Mr Etho. The growling had now crescendoedinto roars, and the honourable (now “Mastifflike”) Mr Etho decided that the nasogastric tube was nextto go. No, not the nasogastric! Abdominal contents spilling into his lungs on the way up??????

Mum’s thoughts: stay calm…….., someone please, please, please answer the call bell; should I stayor should I go and get help???

Decision was made to stick her head out the door and yell – the honourable (now “Mastifflike”) MrEtho couldn’t possibly get any worse………..

Mum’s thoughts: stay calm…….., someone please, please, please hear me! The situation is totally outof control, I think this is all my fault, I hope he doesn’t die.

As the honourable (now “Mastifflike”) Mr Etho was stuck with his blood soaked leg protruding throughthe bed rails, – at least he couldn’t fall over the top, one small mercy.

Help finally arrived in the form of the wardsman sauntering past after his tea break. The saunteringrapidly turned into a run when he heard the roaring and screaming and crashing of a falling IV pole.The wardsman was so stunned by what he saw that all he could do was gawk! Several times mum hadto yell at him to go and get reinforcements – as many as possible! Meanwhile mum was left trying tohold down his arms, ducking to avoid punches, trying not to trip on the fallen IV pole and blood soakedfloor, and trying to keep that NG tube in-situ. Mum said she learnt that rubber soled shoes becomeextremely slippery when they come into contact with a floor being rapidly covered in copious freshblood, and “if it wasn’t for the adrenaline coursing through my veins I would have been a blubberingmess huddled in the corner” – that came later…….

Real help quickly arrived – two RNs, the RMO, and following on, the resusc team. But even trying tohold the honourable (now “Mastifflike”) Mr Etho down required four staff members with very bigmuscles – his level of anxiety, aggression, and probably fear, escalating the more we tried to restrainhim. It is amazing just how much strength a person can acquire during a state of such mania!

Even with successful restraint, the resusc team had to try and find venous access to administersedating medication. Long gone was his IV cannula, and with thrashing arms and legs and gnashingjowls, the team had to settle for intra muscular administration, and then wait until it took effect.

Twenty minutes passed and still the honourable (now “Mastifflike”) Mr Etho maintained his level ofanxiety, aggression, and probably fear, thrashing and roaring. More IM medication administered – morewaiting and restraining. Was the honourable (now “Mastifflike”) Mr Etho hypotensive? hypovolaemic?hypoxic? tachycardic? about to die? – No way of knowing as it was impossible to check his vitals andwith no IV access, impossible to administer any fluids.

Mum’s thoughts: stay calm…….., the situation is totally still out of control, I think this is all my fault,I hope he doesn’t die, I hope my other patients don’t need anything because it’s just too bad if they do!

An hour after the arrival of the cavalry, the honourable (now not quite so “Mastifflike”) Mr Etho beganto calm down and 15 minutes later the resusc team had achieved a level of sedation adequate to transferthe honourable Mr Etho to high dependency for assessment, monitoring, and patching up.

Mum was left with clearing the devastation, and catching up on her other patients. She described theroom as looking like one from a murder scene. The soiled blood-soaked bed linen strewn across thefloor mixed with blood covered IV pole, discarded IV infusion bag, mattress and bed rails covered inblood, discarded wound dressings where the team had attempted to stem the flow of the honourableMr Etho’s haemorrhaging from arm, abdominal drain site (they were quite large back in those days),and leg.

Mum didn’t even attempt to clean her shoes; she threw them out as soon as she could get them offher feet and the long shower she took couldn’t wash away her feelings of distress for the honourableMr Etho, and her feelings of failure and guilt.

So the next time you have to make a PACE (MET) call for a slightly abnormal parameter, and perhapsthinking what a waste of time it is, remember Mr Etho being “a little bit agitated” with a “slighttachycardia”, and remember my mum.

Find more stories at www.nswnma.asn.au/nswnmamembers/short-stories-and-poems-2014/


I park my work car at the end of a country lane, the jacarandas are gently framing the edges ofhistoric streets, the old cottages are nestled in old gardens. I can hear birds deep in the trees and itis like time has stood still. It is a sleepy village.

I take a big breath of winter air. I have not met this palliative care patient before. I have to force thewrought iron gate open and the latch is stiff with rust, I make a mental note to go around the back atmy next visit. I am surprised when someone answers the front door, it is so still and quiet. The doorstruggles to scrape across the carpet and it is a slow greeting to the patient’s carer. She looks hostiletowards me even after I have introduced myself. “I can’t do this any more, I have a bad back and I justcannot do this any more!” She is his resentful ex-wife. I can see that she is exhausted and has reachedher limit. Her deep wrinkles speak to working hard and playing hard. Now she just looks hard. She isgreyhound thin and twitchy for more than her next cigarette. Her tight hipster jeans swing ajangle ofchains and keys.

Her mobile phone hangs from her grooved neck in a pink shoe sock. She looks older than she is andher agitation punches her chewing gum and forces her pacing.

Then I see him. I have never seen anyone so close to death sitting upright. He looks frightened andI shake his frail hand putting all my kindness into my smile. He is jaundiced, his leaving eyes fluoroyellow, his jaw slack and skin swollen with malignancy. We talk for a while, I am gentle and quiet andit seems to be what he needs. I take on his energy and vocabulary – we talk about being “buggered”,“pulling up stumps”, “hitting the wall”, about being “stuffed”. I talk with tenderness and it is like wehave known each other a long time. I gain his trust as I hold his cold purple hands. I try my pulseoximeter but cannot get a reading. I cannot find a manual pulse. I keep talking quietly and knowinglyand he points me to his feet. He allows me to unwrap his velcro joggers and soaked socks – his freezingfeet have pitting marbled oedema, his skin is an inkpad taking my fingerprints. I hold his feet like aprayer and take the moment with him. It gives me pause and I feel the humility and complete privilegeof this time. I check his mouth but I didn’t need to, he is frothing thrush and unable to swallow. Heshifts uncomfortably and I ask his ex-wife for any analgesia. He has none. We find expired Nurofen inthe back of the kitchen draw. He cannot swallow the second tablet.

I change chairs so I can face him directly. It is just him and I. He looks at me with questions in hiseyes and enormous sadness. I know he wants to die at home. I know his carer cannot look after himany more. She has hurt her back and there is no one else to help. A son. But he works. A son? I amhopeful. Maybe he can help? No. He is busy, he is the chancellor at a city university. I have manythoughts at once – I think family, money, time, rescue, wild card. I choose to say, you must be veryproud of him. It turns out to be the right thing to say … he nods and there is a rare smile. I meet histired, accepting eyes. Is there any unfinished business? I ask. Is there anyone that you want to see oranything that you need to do? It seems too difficult to stay at home. You are losing ground. I think thatyour time is very short, I don’t think that you have very long to live now. His eyes meet mine. His voiceis suddenly strong. How long? We maintain eye contact. Anytime from here on, a day or two, not muchmore than that. His shoulders come down, he relaxes and there is another smile. I am glad he says,that is such a relief. Thank you. He squeezes my hand and I win a wink.

I spend the rest of my time talking to doctors, bed managers and the ED. I speak to his chancellorson who insists dad goes to a private hospital. I encourage him to come see his dad. I tell him he isdying and if he wants to see his dad he cannot wait for end of term. He will check his schedule.

I come in to say goodbye to him after my calls and he is laying down on the lounge now, nursing ahot water bottle on his lap. I tell him the ambulance is coming soon. Never been in an ambulancebefore. His face is lighting up. Will it have sirens? I tell him he can ask them to have the sirens on. Hebeams. You are easy to please, I tell him, grinning. He tells me he feels so much better now. He looksdifferent and there is a peace about him. We shake hands by way of farewell. Go easy I tell him. Youtoo he says. We share the look that says we will not see each again and that is enough.

THE AMBULANCEB Y K AT H E R I N E W U R T H

SHORT STORY AND POETRY COMPETITION


New on SupportNursesYouTube channelUnhappy anniversary: WorkCover

Emily Orchard RN on the second anniversary of cuts to WorkCover.> youtu.be/VqNuKT4AeG0

Disgraceful attack on Medicare

Kerry Rodgers RN speaks at a rally in Sydney’s east.> youtu.be/9dwA9uMzDVA

Follow us on Twitter NSWNurses & Midwives @nswnma Watch us on YouTube SupportNurses

SOCIAL MEDIA

Do you have a story to tell? An opinion to share?nurse uncut is written by everyday nurses and midwives.

Send us your ideas at [email protected]

NURSE UNCUTA BLOG FOR AUSTRALIAN

NURSES AND MIDWIVES

www.nurseuncut.com.au

Never too late to go back to study

www.nurseuncut.com.au/never-too-late-to-go-back-to-studyTwenty-five years after training as a nurse/midwife, Kate Dove went back to university to get her Masters in Midwifery – and loved it.

The path to a private health system – do we want to take it?

www.nurseuncut.com.au/the-path-to-a-private-health-system-do-we-want-to-take-itCoral Levett examines the two competing views of how health services should be pro-vided. Are we at a crossroads?

Nursing on St Helena – an island in the Atlantic

www.nurseuncut.com.au/nursing-on-st-helena-an-island-in-the-atlantic-oceanAustralian mental health nurse Ian Rummery writes about life and work on the tiny British island of St Helena.

My budget concerns

www.nurseuncut.com.au/my-budget-concernsEmergency nurse Angie Gittus lists the many things about the federal budget thathave her worried.

A mini crisis for GP nurses

www.nurseuncut.com.au/gp-nursing-crisis-after-devastating-medicare-announcementPrimary care nurses were shocked to discover their assessments were no longerclaimable on Medicare – but the government backed away after pressure from nursesand GPs.

An injured nurse speakswww.nurseuncut.com.au/an-injured-nurse-speaksKaren was seriously injured in a violent attack at work but cuts to workers’ compensation led to her losing out.

New South Wales Nurses and Midwives’ Association >> www.facebook.com/nswnmaRatios put patient safety first >> www.facebook.com/safepatientcareAged Care Nurses >> www.facebook.com/agedcarenurses

HOTWHAT’S

THIS MONTH

Connect with us

on Facebook

Look for your localBranch page on our website.

Nurse Uncut is also on Facebook:www.facebook.com/NurseUncutAustraliaand on Twitter @nurseuncut

Yes, we’re on Instagram, so shareyour local photos with us @nswnmaand #NSWNMAforce4change.

NSWNMA on Instagram!

It’s ti

ime

x the order form to , (02) 9662 1414,yy,

o: NSWNMA, aterloo NSW 2017ue, W

[email protected]

dise order forms available on

wnma.asn.au

FORMR rub top $20.

S M XL 2XL 4XL

rub pant $20.

S M XL 2XL 4XL

der $ postage and handling

POSTCODE

YMENTAAYMastercard VisaMoney Order

DER

TEY DAATEXPIRRY /

b fto scrub up ft t

Order your NSWNMA campaigconference and rally times, and

for 2014ms for gn scrub unifor

d make an impression!

!, faxo orderr,TTo

Glen Gintypost to

venu50 O’Dea AAvgenseemailrro

Merchand

also a

.nswwww

ORDERNSWNMA ScrQuantity: Size: XS

SCRU

B TO

P Size (cm)

Half Chest Circumference

Half Hem Circumference

aist (Relaxed)

aist (Stretched)

XS S M

ANTS

53 56 59

General Guide for Female

54 57 60

8/10 10/12 12/14

CRU

BPPA

Half W 29 33 37

Half Hip

WflaH 47 51 55

O t S L th

55 59 63

103 105 107

Size: XS L 3XL

NSWNMA ScrQuantity: Size: XS

L 3XL

otal cost of ordTToPlease include p

L

62

63

40.5

58.5

XL 2XL 3XL 4XL

66 69 73 77

14/16

67 70 74 78

16/18 18/20 20/22 22/24

43.5 46.5 50.5 54.5

66

61.5 64.5 68.5 72.5

109

69 72 76 80

111 112 113 114

SC Out Seam Length 103 105 107

Please include p.of $5 per order

NAME

ADDRESS

PHONE (H)

(W)

109 111 112 113 114

(W)

(MOB)

AMETHOD OF PPA Cheque M Bankcard M

NAME OF CARD HOLD

NUMBERCARD

TURESIGNAAT


SOCIAL MEDIA

SAID & LIKED on facebook www.facebook.com/nswnma

Keep me logged in Forgot your Password?

NURSES & MIDWIVESWHAT

Dementia blowout

PHOTO GALLERY

Security concerns

Kempsey nurses wore red onJune 30 to show they intend tokeep on fighting for ratios.

Bankstown Hospital branch isstanding up for Medicare –#copaynoway

Canterbury Hospital branchmembers don’t want a US-stylehealth system in Australia.

Central Coast nurses hitTuggerah station on a colddark morning to talk tocommuters about ratios.

Please support our colleagues, keep each other safe. Report every act of violence, not onlyvia your workplace incident report but also notify the police. I was assaulted at work andthe offender was jailed.

If the patient was cooperative during transport with the ambos then the risk of a suddenoutburst was probably assessed as low. You can’t sedate a guy solely on his history.

Given the planned closure of Hunter Residences there definitely will be an increased risk forED staff and patients when clients are transitioned within the community. It is aforeseeable risk so more needs to be done.

After several nurses were assaulted by a patient atJohn Hunter Hospital the NSWNMA voicedconcerns about security and emergency protocols.

Sad death

Understaffing and lack of ratios in aged care werecited as factors in the sad case of a death in a NewSouth Wales nursing home.

This is an absolute disgrace. Dementia is on the increase as well as severe behaviours. Agedcare staff, we really need to get loud!

The government has totally lost the plot.

This is going to put more pressure on state hospitals; f inding beds for [moderate] to severedementia patients is not easy ... And now facil it ies are not even remunerated? What incentivedoes a facil ity have for taking on these patients? They have really underestimated the skil l andexpertise required!

Giving more support to carers keeps people at home longer and is a lot more cost-effectivethan having people in residential care.

The people who have worked hard all their l ives to build this country are apparently worthnothing.

The federal government axed the dementia anddifficult behaviours supplement saying there’dbeen a cost blowout. Isn’t there a dementiablowout due to the growing number of olderpeople?

All inspections should be unannounced with less emphasis on paperwork.

Accreditation in its early years did have a lot of impact on the care given but now it is awaste of money, which is paid for by the providers, who in turn cut corners e.g. staff.

Most places have a really good idea of when unannounced visits are due. The problem lieswith staffing levels, RNs being replaced by endorsed cert IVs who will never have the levelof expertise of an RN, and profit being the main objective even in the so-called not-for-profit companies. The state government should be held accountable if the accreditationprocess is fall ing short.

The main problem I feel as an AiN is understaffing and that goes back to management. Iknow of a place that has 33 dementia residents … they have ONE night nurse on! As anurse it sickens me. It’s unfair on residents and nurses!

I love my job and my oldies but some days I am so stuffed I cry. When will they see we needmore staff, more funding and less bloody paperwork to be able to give these people the careand comfort they deserve?

From my experience in aged care the expected standards are high, but staff numbers are notnear enough to ensure these standards can be properly maintained. There also needs to be amandated ratio of RNs per resident.

Staff [members] are the scapegoats of a money hungry industry.

It is way past time for a Royal Commission into the aged care industry.


Apply online

Australian College of Nursing is proud to be the fund administrator for this program.An Australian Government Department of Health initiative supporting nurses and midwives.

1800 117 262| [email protected]| .acn.edu.auwww

NURSING & MIDWIFERY

:saerng aiwolloe fhn ts ieviwdis & mesrur noe flbaliave ars apihsralohcS

SCHOLARSHIPS

> undergraduate

> postgraduate

> continuing professional development

> nurse re-entry

> midwifery prescribing

> nurse practitioner

>

Open 21 July 2014 – Close 15 September 2014

continuing professional development.emergency department clinical and non-clinical

Senator Fiona Nash, Assistant Minister for Healthincent's Hospital, SydneySt V

, dinatorMr Douglas Holmes, Consumer Participation CoorCountry Health South Australia Local Health Network

, Mental Health, ectorMs Rebecca Graham, Executive DirDr Joseph Dunn, Psychs on BikesMr David Butt, CEO, National Mental Health Commission

Keynote Speakers Include:

12th

MentalAustrath6

emote communities.

.anzmh.asn.au/rrmhwymercial club albur

vember 2014h - 14th no

Symposiuml Healthalian Rural & Remote

d r

ent sessions and workshops that develop skills oncurrhe symposium will include keynote speakers,

egular basis. ese challenges on a re faced with give voice to those practitioners who ar

oice, seeks s Vhe Symposium theme, The Practitioner’mited access to mental health services and support.

eater challenge with emote community faces a grd r, the rural es. Howeveromparable to major urban centr

eas is estimated to be emote aroblems in rural and rhe number of Australians experiencing mental health

Th

wwwcom

limanco

oprTh

d October 2014.

eens anright, The GrSenator Penny Wand Remote Mental Health

, Alliance for Rural of Russell Roberts, National ChairA/PrUniversity of Newcastle

e for Rural and Remote Mental Health, The Centrch, ofessor of Rural Health Researof David Perkins, PrPr

Friday 3registration endsd rreinformation. Early bir

eisit the Symposium website for morV

coThtheto Th

1 2 3 4 5 6 7 8

9 10

11

12 13

14 15

16 17 18 19 20 21 22 23

24 25

26

27

28 29 30

31

32

Across1. A herniation of the diaphragm (16)9. Occurring every eight years (9)10. An organism requiring oxygen to

live (6)11. Laryngeal intraepithelial neoplasia

(1.1.1) 12. To dry up (9)13. Lacking brightness or color; dull (6)14. Virus responsible for a severe and

often fatal hemorrhagic fever inprimates (5)

15. The friction of a surface to facilitateabsorption of an ointment (10)

16. Trypanosomiasis (8.8) 24. Red blood cell (1.1.1)

25. Lawful (5)26. A temporary state of mental

confusion (8)27. An officer appointed to inspect (9)28. The substance composing the inner

layer of the periosteum, from whichbone is formed (8)

32. Extradural hemorrhage (8.8)

Down1. Gross self-neglect, usually in the

elderly (8.8) 2. Periscope (9)3. The act of clasping the hand of

another (9)

4. Excessive, purposeless cognitiveand motor activity orrestlessness (9)

5. A rounded bony process, such asthe protuberance on each side ofthe ankle (9)

6. In ultrasound, the completetransmission of sound so theimage appears black (9)

7. The material within a cell nucleusfrom which the chromosomesare formed (9)

8. Involving great exertion or longeffort (9)

17. To remove by cutting (6)18. Being inactive (6)

19. Having the nature of a germ cell(8)

20. A notch (8)21. The presence of potassium in the

blood (8)22. A fungus, used in herbal

medicine for strengtheninguterine contractions duringchildbirth (5)

23. A hardened patch or indurationof skin or mucous membrane (8)

29. Transient Cognitive Impairment(1.1.1)

30. Observation care unit (1.1.1) 31. The main magnetic field

measured in teslas (2)

test your

knowledge


Customise your Master of Nursing The UTS experience is person centred learning.

Flexible entry and exit points including credit for Graduate Certificates from other universities and College of Nursing courses.

4 majors

9 clinical

sub-majors

50+ elective subjects

health.uts.edu.au/pginfo

1846

7

UTS CRICOS PROVIDER CODE 00099F

UTS:HEALTH

WHAT’S ONAUGUST 2014

EDUCATION@NSWNMA

——— • ———Computer Essentials

for Nurses and Midwives – 1 day6 August Prince of Wales Hospital, Randwick

Members $85 Non-members $170——— • ———

Appropriate Workplace Behaviour – 1 day13 August Port Macquarie

Includes understanding why bullying occurs; anti-discrimination law; how to behave appropriatelyin the workplace; what to do if subjected to unlawful

harassment and bullying.Members $85 Non-members $170

——— • ———Are you meeting

your CPD requirements? – ½ day14 August Port Macquarie

10 September Batemans Bay25 September Dubbo

Suitable for all nurses and midwives to learn aboutCPD requirements.


Legal and Professional Issues for Nurses and Midwives – ½ day

15 August Port Macquarie11 September Batemans Bay

26 September DubboTopics include Health Practitioner Regulation

National Law, potential liability, the importance ofdocumentation, the role of disciplinary tribunals and

writing statements.Members $40 Non-members $85

——— • ———Basic Foot Care for Nurses – 2 days

20 – 21 August NewcastleMembers $203 Non-members $350

——— • ———Enrolled Nurses Forum – 1 day

22 August NSWNMA, WaterlooMembers $30 Non-members $50

——— • ———Aged Care Seminar Series – 1 day

28 August Batemans BayMembers $75 Non-members $170

——— • ———Tools in Managing Conflict and Disagreement – 1 day3 September Parramatta


To register or for more information go towww.nswnma.asn.au/education

or phone Matt West on 1300 367 962


NURSING RESEARCH ONLINE

Abbott government attacks on bulkbilling and public hospitals areunmistakably a strategy to underminethe very fabric of Medicare. Thecoalition doesn’t believe in the valueof publicly-funded, universal access tohealth and never has. If you are in anydoubt about how realistic thewarnings about the destruction ofMedicare are, look at what the DavidCameron led coalition government isdoing to the NHS in the UK.

Can we afford the NHS?John ApplebyBritish Medical Journal 2011;343:d4321

In an article for the Daily Telegraph in June, AndrewLansley, England’s Health Secretary, made an inter-esting prediction. By 2030, he said (referring to Eng-land), “If things carry on unchanged, this would meanreal terms health spending more than doubling to£230 billion.” He also stated that, “This is somethingwe simply cannot afford.” It is of course then a short step to an argument thatthe NHS must change (because unchanged equalsunaffordable) and that the change it needs are theSecretary of State’s reforms. This is a version of the“politician’s syllogism”:

1. The NHS must change (otherwise it isunaffordable).2. This (the reform) is change.3. Therefore we must do this (the reform).

As subsequent changes to the NHS reforms haveshown, such logic is debatable. But perhaps thepremise is also questionable. £230bn is certainly a lotof money – as Mr Lansley points out, that’s equivalentto spending at a rate of over £7000 a second. But inwhat sense is it actually unaffordable? If the NHS inEngland were currently consuming £230bn, then asa proportion of GDP this would amount to 18% ofGDP devoted to health. That compares with the actual figure of 8.5% of GDP. But the £230bn is notspending now, but what spending might be in 20years’ time. It is equivalent to average real increasesin spending of just over 4% a year – a bit more thanthe long run average for the NHS since 1948.Crucially, however, the country’s capacity to affordhigher spending will change over time. Over the next20 years it is likely that the economy will grow invalue. The real question to ask about health spending iswhat we think we might get in return as a result offorgoing the benefits of spending increasingamounts of our wealth on other things. For example, is the two year increase in life ex-pectancy at birth we might possibly enjoy as a resultof higher health spending, worth the benefits we willnot get to enjoy from spending more on education,food, or housing?www.bmj.com/content/343/bmj.d4321.full.pdf+html

NHS Expert Legal Advice38 Degrees

38 Degrees members donated to fund independent legal advice on the implications of theBritish government’s proposals to change the NHS in England. Solicitors were engaged to givetheir opinions on two aspects of the Health and Social Care Bill.The Bill will remove the duty of the Secretary of State to provide or secure the provision ofhealth services, which has been a common and critical feature of all previous NHS legislationsince 1946. This is the means by which Parliament ensures the NHS delivers what the publicwants and expects. Furthermore, a “hands-off clause” will severely curtail the Secretary of State’sability to influence the delivery of NHS care to ensure everyone receives the best healthcarepossible. The Bill also contains a number of measures that will increase competition within the NHS atthe expense of collaboration and integration and/or make it almost inevitable that UK and EUcompetition law will apply as if it were a utility, like gas or telecoms. What this could all mean: • No longer a National Health Service The NHS will be little more than a series of quasi-independent commissioning entities andproviders, basically free to get on with the job. • Loss of Accountability – the government washes its hands of the NHS Removing the Secretary of State’s legal duty to provide or secure provision of health services,and introducing a “hands-off clause” significantly reduces democratic accountability for theNHS.• Postcode lottery Because of changes in the bill there is a real risk of an increase in the “postcode lottery” natureof the delivery of some NHS services. Patients can no longer expect the government to ensurea consistent level of healthcare regardless of where they live. • Exposing the NHS to competition lawTaken together, these changes increase the likelihood of NHS services being found by the courtsto fall within the scope of UK and EU competition law. • Costly and complex procurement proceduresThe new commissioning groups will be subject to EU procurement rules when they commissionlocal health services. This could mean that the NHS ends up spending a lot of time and moneyfighting legal action instead of investing in patient care. Or worse, it could mean they are reluc-tant to commission any services for fear of being sued. • Fertile ground for private health companies (and their lawyers)Companies that bid unsuccessfully for NHS contracts will be able to challenge commissioningdecisions in the courts. Private health providers have far more expertise and legal capacity thaneither public bodies or charities, and so are likely to be best placed to exploit these laws. • Opening our NHS to private companies – privatisation by stealthThese plans will lead to a system geared heavily in favour of private companies. www.38degrees.org.uk/page/content/NHS-legal-advice/


Quality legal advice for NSWNMA members

Call the NSWNMA on 1300 367 962 and fi nd out how you can access this great service.

c Compensation and negligence claimsc Employment and Industrial Lawc Workplace Health and Safetyc Anti-Discrimination c Criminal Lawc Free standard Wills for membersc Probate / Estatesc Public Notaryc Discounted rates for members including First Free

Consultations for members on all matters.Offi ces in Sydney and Newcastle with visiting offi ces in regional areas (by appointment).

e Lions Nurses’ Schos for scholarships for

ships must be resident .NSW or ACT.

with the Nursing andworking within the

, and must haveACT,ence in the nursing

produce evidence thatr the required period of

l hi il bl

Looking for funding to further yo

LIONS NURSES’ SC

ustees of thehe trTinvite applications

Nurses eligible for these scholarsand employed within the State of

ou must currently be registered wYMidwifery Board of Australia and nursing profession in NSW or the a minimum of three years’ experie

. profession in NSW or the ACTT.

Applicants must also be able to pyour employer will grant leave forthe scholarship.

D t il f li ibilit d th h

oundation olarship Fr 2015.

our studies in 2015?

HOLARSHIP

lications must be in the hands of the secretary no later than 31 October 2014.

larships availableher withincation forms a.asn.au

dationW 2017

67 962

Completed appl

Details of eligibility and the scho(which include study projects eithAustralia or overseas), and applicare available from: .nswnmawwwThe SecretaryLions Nurses’ Scholarship Found

venue, Waterloo NSW50 O’Dea Aor contact Matt West on 1300 36or [email protected]


BOOKS

An Introduction to Community andPrimary Health CareEdited by Diana Guzys and Eileen PetrieCambridge University Press www.cambridge.org RRP $POA ISBN 9781107633094

Community nursing is the fastest growingarea of nursing practice in Australia. Thisbook offers an introduction to the theory,skills and application of community and pri-mary health care. Based on the “Social Modelof Health”, An Introduction to Community andPrimary Health Care explores how social andenvironmental factors impact upon health-care in Australian communities. It discussesthe principles of health and mental healthpromotion, the importance of cultural com-petence and the practice of community needsassessment. The book is divided into threeparts: theory, skills and health professionalsin practice. This latter section encouragesstudents to consider how various nursingroles address the issues of social justice,equality and access.

Clinical Cases: Medical-SurgicalNursing Case StudiesJanine BotheMosby Australia (available through ElsevierAustralia) www.elsevierhealth.com.auRRP $36.32 ISBN 9780729542074

Based on real life scenarios this series presents case studies complete with solutions,giving nursing students an opportunity toexplore the scenarios they are likely to encounter in a variety of practice settings.This text would be useful during exam prepa-ration or as a study tool, providing an en-gaging approach to learning and revision.

Fast Facts for the ER Nurse:Emergency Room Orientation in a Nutshell (2nd ed.)Jennifer R. BuettnerSpringer Publishing (available through FootprintBooks) www.footprint.com.auRRP $34.95 ISBN 9780826199461

Chapters in this textbook provide a briefoverview of the equipment, treatments anddrugs used to manage common disordersand conditions frequently seen in the ER.The book includes disorder definitions, signsand symptoms, interventions, drugs, and crit-ical thinking questions. Using a bullet-pointformat each chapter is organised alphabeti-cally by disease and disorder within each bodysystem. The book offers a structured approachto orientation.

BOOK ME

Handbook of Evidence-BasedPractices for Emotional andBehavioural Disorders: Applications in SchoolsEdited by Hill M. Walker and Frank M. GreshamGuildford Press (available through FootprintBooks) www.footprint.com.au RRP $115.00ISBN 9781462512164 (hardback)

This authoritative volume provides state-of-the-art practices for supportingthe approximately 20% of today’s K-12students who have emotional andbehavioural disorders (EBD) that hinderschool success. Experts present evidence-based approaches to screening, progress monitoring, intervention, andinstruction within a multi-tiered framework. Coverage encompasseseverything from early intervention and prevention to applications for high-risk adolescents. Exemplary programs are described for broad populations ofEBD students as well as those with particular disorders, including autismspectrum disorders and externalising behaviour problems. The bookcombines theory and research with practical information on how to selectinterventions and implement them with integrity.

SPECIAL INTEREST

All books can be ordered through the publisher or your local bookshop. NSWNMA members can borrow the books featured here, and many more, from our Information and Records ManagementCentre (IRMC). Contact Jeannette Bromfield [email protected] or Cathy Matias 8595 2121 [email protected]. All reviews by NSWNMA IRMC Coordinator/Librarian JeannetteBromfield. Some books are reviewed using information supplied and have not been independently reviewed.

NEW! The NSWNMA Library Catalogue is now online!Visit www.nswnma.asn.au/library-services-online-library-catalogue/ for thelink to open the catalogue, plus instructions on how to use it. Once youhave searched by keyword or browsed the subject areas available you cansend loan requests directly to the Library via a quick online form. Many online resources can be accessed directly through web links included in the catalogue listing.

Humanizing Healthcare ReformsGerald A. Arbuckle with foreword by Dr Maria Theresa HoJessica Kingsley Publishers www.jkp.comRRP $34.95 ISBN 9781849053181

This book examines the ever-increasing organisa-tional and cultural turmoil in healthcare institutionsand suggests how reforms, based on foundationalvalues, can be achieved and maintained. Looking atthe turmoil facing contemporary healthcare systemsworldwide, resulting from the imposition of financialperformance indicators, the author argues that a return to a values-based approach to healthcare willcreate positive transformation. Writing from thefresh perspective of social anthropology he takes ahighly pragmatic approach to practice, emphasisingthe importance of values such as compassion, solidarity and social justice. This book will be usefulfor anyone interested in a better approach to health-care reform, from clinicians and nurses, to managersand policy makers, as well as the interested reader.


Email The Lamp by the 10th of the

month to be in the draw to win adouble pass to Magic in the Moonlightthanks to eOne Entertainment. email

your name, membership number,

address and telephone number to

[email protected] for a chance to win!

MOVIES

moviesof the month

This film written and directed by Woody Allen and set in the1920s is romantic and old-fashioned, writes Stephanie Gray.

The film stars Colin Firth as British magician and master illusionist Stanley Crawford, who performs under the alias WeiLing Soo. His best friend Howard sends him to the French Riviera to debunk the practices of spiritualist Sophie (Emma Stone).

Sophie and her pushy stage mother have taken up residence in a chateau inthe south of France, owned by the naïve and sweet-natured Grace ( JackieWeaver). Grace, an extremely simplistic, but likeable, person, is desperate tomake contact with her departed husband. Her son Brice is madly in love withSophie.The accuracy of Sophie’s sooth saying and her impressive trickery challengesStanley’s cynicism and he too finds himself falling for her charms.What follows is a series of events that are magical in every sense of the wordand that send the characters — and the audience — reeling. The romantic setting of the Roaring 20s and the fantastic location lend thefilm a natural enchantment. In the end, the biggest trick Magic in the Moonlight plays is the one that foolsus all, love.Stephanie Gray is an RN with the Australian Red Cross Blood Services

IN CINEMAS AUGUST 28

MAGIC IN THE MOONLIGHT

METROMEMBERGIVEAWAY

DVD SPECIAL OFFER

Email The Lamp by the 15th of this month

to be in the draw to win a dvd of

Micro Monsters thanks to Roadshow

Entertainment. email your name, membership

number, address and telephone number to

[email protected] for a chance to win!

RURALMEMBERGIVEAWAY

David Attenborough takes you on anamazing journey into the hidden world ofbugs using pioneering macroscopic cameratechniques. Micro Monsters gets closer thanever to the fascinating, beautiful, scary anddownright alien world of arthropods:spiders, scorpions and insects. Attenboroughreveals how and why bugs became the mostsuccessful group of animals on the planet,outnumbering humans billions to one andable to survive environments deadly to us.Ranging from the earliest simple organismsmillennia before the dinosaurs, throughtheir evolution into a bewilderingly diversenumber of types and species, Micro Monstersshows the tactics these creatures use tosurvive and thrive. Armies of killer ants,spiders weaving silken trap doors, beetlesshooting boiling chemicals at their enemies,bees communicating, deadly scorpions witha beautiful mating dance, termites that buildair conditioned skyscrapers and theincredible double life of butterflies – allthese and more presented by the world’sfavourite naturalist.


Confessed Nick Cave fanSue Miles defies anyonenot to like him afterwatching this film.

20,000 Days on Earth, adrama-documentary, portrays a fictionalised 24

hours in the life of Australian musician andwriter, Nick Cave.Directed by Iain Forsyth and Jane Pollardthe film was inspired by a calculation Cavehad made in his songwriting notebook,working out his time on earth. 20,000 Days on Earth certainly takes an unconventional approach. “The thing that seems so kind of prevalentin contemporary music docs is that they’reall about getting behind something, reveal-ing something, taking away the mask, taking away the myth,” Forsyth has said.“The important thing for us was not break-ing the mythology.” This fits with the duo’s work as visual artists:they have in the past restaged DavidBowie’s final performance as Ziggy Stardust and the Cramps’ 1978 gig at NapaMental Institute, and made two films aboutthe emotional potency of mix tapes. The film takes you almost literally, withNick Cave at the wheel, on a journeythrough layers of fiction within layers of theperformer’s past: the Birthday Party, Berlin,the Bad Seeds, a fabulous story about NinaSimone and so much more.One key sequence takes place in the NickCave Archive, fictitiously transposed toBrighton from its home in Melbourne.Photographs of a 1981 show by Cave’s in-fluential post-punk band the Birthday Partyare projected on to a concrete wall, eachsequentially detailing the trajectory of afan’s urine spilling onto the stage. Cave speaks to the advancement of imagesas each frame from this fleeting momentof chaos presents a new avenue of intro-spection, historical reminiscence and personal history.

Deconstruction of such moments – moments whose incorporation into popular mythology illustrates the mutualexchange between anarchic spontaneityand the oft-rehearsed structures of rockand roll – is Forsyth and Pollard’s work.Intimate family time, watching a moviewith his 10-year-old twin boys in Brighton,eating pizza, moments of Nick being justa dad, except they can all recite the scriptof the film they are watching, which happens to be Scarface!I defy you to not like this guy after seeingthis film. Documentary or fiction it’s brilliant. Live music is transformational, being partof the audience often a privilege, especiallywhen you witness magic. This film capturesthis in abundance and delivers on manylevels.Sue Miles works in perinatal mental healthat the Royal Hospital for Women, Randwick

IN CINEMAS AUGUST 21

Email The Lamp by the 10th of the

month to be in the draw to win adouble pass to 20,000 Days on Earththanks to Madman Entertainment.

email your name, membership

number, address and telephone

number to [email protected] a chance to win!

METROMEMBERGIVEAWAY

20,000 DAYS ON EARTH

OFIT FE ALIF

TAATDEASHDDA

ORANDTH

HESkinson

SE R

running. I n as a kid and

wd. But nol

ASHDDAClaire Wilki

Y NUEMERGENCC

ed ys enjoyawe alI’veemanry Fidolised Cath

eamt of winning godr

eamt of winning goe running is about moras. In one shift I cfitnes

than 6.8km - and thaty Thnight. Which is wh

echnicians fitoot Fit TTFea pair of shoes that ar

e. Sometimabland dureneran mean the diffc

e and death. The delife and the speed wmak

than fun and e er morvon c

s on a quiet ’s e’ethe Athl

ed me with tte ablortomfe c

ond es, a seceen e betwnc

e ecisions we with which w

+

es all tharry them makc

e. encerhe diff

S NSWOSCRORES AVER 45 STO1800 677 621


DIARY DATESconferences, seminars, meetings

NSW

Vascular Focus: Management of PeripheralArterial Disease8 August Liverpool [email protected]/Liverpool/events.htmlWe Work With Wounds: Preventing,Assessing and InterveningAWMA (NSW)22 August Westmead [email protected] 9696 121014th Rural Critical Care Conference22-23 August Tweed Heads [email protected] Better Practice Conference: Aged Care28-29 August Sydneywww.accreditation.org.au/education/better-practice-2013/Smart Strokes 2014 28-29 August Sydneywww.smartstrokes.com.ausmartstrokes@theassociationspecialists.com.auNSW Drug and Alcohol Nurses Forum5 September Sydney [email protected] Bugs Seminar5 September [email protected] annual NSW Health and AmbulanceBowls Tournament7 September St John’s Park Bowling ClubPaul 9828 5391 (business hours)[email protected] Management Seminar12 September Wollongong [email protected](02) 4253 4426Day Surgery Nurses NSW 2014 Conference –13 September Darling [email protected] (02) 9799 1632Children’s Hospital at Westmead PaediatricPerioperative Seminar13 September [email protected]@health.nsw.gov.au

Enrolled Nurse Conference18-19 September Tweed Heads1300 554 249Spiritual Care in Contemporary NursingPractice – Nurses Christian Fellowship NSW20 September • www.ncfansw.org3rd Asia-Pacific International Conference onQualitative Research in Nursing, Midwiferyand Health1-3 October Newcastle www.icqrnmh.infoPain Interest Group Nursing Issues Professional development day17 October Sydneywww.dcconferences.com.au/pigni2014Professional Association of Nurses inDevelopmental Disability Areas Conference15-16 October Parramattawww.pandda.netNursing and Midwifery Unit ManagersSociety of NSW Annual Conference17 October Ettalong Beachwww.numsociety.org.auBlacktown and Mount Druitt HospitalNursing and Midwifery Research andInnovation Symposium23 October: abstracts 8 August Abstracts: [email protected] 266 642Symposium: Caroline O’Donnell 0422 006 786 APNA Continuing Education for Nurses inGeneral Practice24-25 October Sydneywww.apna.asn.au/nigpBones on the Beach25 October [email protected] Midwifery Conference 20141 November Sydneywww.slhd.nsw.gov.au/rpa/[email protected] Society of AnaesthesiaParamedical Officers National Conference1-2 November Alburywww.asapo.org.auHigh Dependency Nursing Conference7 November Westmead [email protected]

6th Australian Rural and Remote MentalHealth Symposium12-14 November Alburywww.anzmh.asn.au/rrmh/Spotlight on Liverpool LivesA talk by Liverpool-born Dr Jennifer Harrison13 November Liverpool City Library10.30am-12pm

ACT

3rd Biennial Australian Capital RegionNursing and Midwifery Research CentreConference16-17 October Canberrawww.rcnmp.com.auAustralia and New Zealand Society forVascular Surgery Annual Conference11-13 October Canberrawww.vascularconference.com/2014/

INTERSTATE

Nursing Informatics Australia 2014 11 August Melbourne www.hisa.org.au/page/hic2014niaHealth Informatics Conference 201411-14 August Melbourne www.hisa.org.au/page/hic2014/Aged Care Informatics Conference13 August Melbournewww.hisa.org.au/page/hic2014aciDementia and Recreation NationalConference20-21 August Melbournewww.totalagedservices.com.au/index.php?q=dr-conference.html15th International Mental HealthConference 201425-26 August Surfers Paradisewww.anzmh.asn.au/conference [email protected] Health Service Conference26-29 August Perth www.themhs.org6th Annual Correctional ServicesHealthcare Summit28-29 August Melbourne www.informa.com.au/conferences/health-care-conference/correctional-services-healthcare-summitAged Care Nurse Managers Conference30-31 October Melbournewww.totalagedservices.com.au/index.php?q=acnm-conference.htmlDementia + Community Care Conference 30-31 October Melbournewww.totalagedservices.com.au/index.php?q=dcc-conference.htmlThird National Elder Abuse Conference3-4 September Perthwww.elderabuse2014.com/index.htmlACSA National Conference 7-10 September Adelaide www.acsaconference.org.auAustralian Disease ManagementAssociation Conference11-12 September Melbourne www.adma.org.au/images/ConferenceFlyer2014.pdfPHAA 43rd Annual Conference15-17 September Perthwww.phaa.net.au/43rd_Annual_Conference.phpParamedics Australasia InternationalConference18-20 September Gold Coastwww.paic.com.auCongress of Aboriginal and Torres StraitIslander Nurses and Midwives 16th National Conference 23-25 September Perthwww.catsin.org.au

ACMHN 40th International Mental HealthNursing Conference7-9 October Melbourne(02) 6285 1078www.acmhn2014.com or [email protected] 2nd National Sexual andReproductive Health Conference18-19 November Melbournehttp://phaa.net.au/NSRH2014Conference.phpAustralasian College for InfectionPrevention and Control Conference23-26 November Adelaide www.acipcconference.com.auAustralian and New Zealand AddictionConference4-6 March 2015 Surfers Paradisewww.addictionaustralia.org.au

INTERNATIONAL

10th Asian and Oceanian Epilepsy Congress7-10 August Singaporewww.epilepsysingapore2014.org/7th World Congress for Psychotherapy25-29 August South Africawcp2014.com; [email protected] World Congress of Clinical Safety10-12 September Spainwww.iarmm.org/3WCCSNurses Christian Fellowship InternationalPACEA Conference 10-14 October Fiji [email protected] International Conference on Violence inthe Health Sector22-24 October USAwww.oudconsultancy.nl/MiamiSite2014/index.htmlInternational Conference on Infectious andTropical Diseases 16-18 January 2015 Cambodiawww.ictid.webs.com

REUNIONS

Royal Newcastle Hospital 40-year reunion RN graduates April/May 1974 30 August Newcastle Wendy Lewis [email protected] 0407 861 722 Sue Carroll (nee Hetherington)[email protected] 0404 083 429SVH Lismore Past Nurses Group 60th reunion30-31 August Marg McGrath 0439 092 333Sue Felsch 0427 834 336 [email protected] Graduate Nurses’ Association reunion19 October North Sydney Joan Taniane 0401 344 [email protected] Henry Hospital PTS Jan 1964Meet-up at annual PHH reunion 25 October Helen Millan (nee Flanagan)[email protected] Henry Hospital April 1964 class reunion25 October Little BayMargaret Vincent (nee Dewick)[email protected] 0413 293 812NEC Prince Henry/PoW Hospitals October 1972-75 group25-26 October Margret Brignall (nee Samuel) 0418 646 959;Sonia Keeling (nee Graf ) 0407 221 407Marcia Jarvis (nee Fitch) 0438 415 647Dianne Walkden (nee Edwards) 0400 621 470Gill Gillon (nee Horton) 0401 048 205Waikato Polytechnic Nursing Graduates 1987-1989 reunion1-2 November New ZealandMolly Forbes 0403 904 [email protected]

Crossword solution

diary dates is a free service for members. Please send event details in the format used here: Event name, Date and location, Contact details; by the 5th of each month.Send your event details to: [email protected] Fax: 02 9662 1414 Post: 50 O’Dea Ave, Waterloo NSW 2017. All listings are edited for the purposes of style and space.

D I A P H R A G M A T O C E L E

I L A G A R H A

O C T E N N I A L A E R O B E

G I D T L I N O O

E X S I C C A T E S O M B R E

N C L T O O A I

E B O L A I L L I N I T I O N

S P S O U I I U

S L E E P I N G S I C K N E S S

Y X D E N A R C

N C L R B C L E G A L

D E L I R I U M I A O E

R S N I N S P E C T O P

O S T E O G E N U M O

M C C A R I B M

E P I D U R A L H E M A T O M A

NWOTKCALB

E1 D.OS N’YENDYN - S

SISN3 &10, 2210R 2ELAE

NA4102

ANIF WEE W

T TRRTAARPPAA

^ELBAILAVVAE AAVCNA,KNIINELLIRRETENCCEEEMMEOOMCCOELLCW

SRRSERREAAR, CCASRRSEKKERRKOORE WWOMMEIIMTE.RRE MO &ECCENAANWWAOOWLLLOAAL

DDDDKIT KITE AV

HI VAITIWI ILM

^

EERFFR

EVISUCLXE UP NMAO LTE

LED & DLOR SAY CCAREVH ETTHIW

iP DPAi

SREDAEE RNIZAGAS MESRU

!410T 2SUGUG ANIRUD DEREVIL *

ARCIM

$IA T $ 616OMRF

REEEF EEEERRREEFFRRR *EE

094 RTT

E

--

R

W

X

RRF EEEEREEEEREFF

KKTOIT

IMI KCCKKITE

TOCSTL

HITIP7 P

IITHITWI

STSATEA7 SE

H O ALALM

TL SIAR $

**EO

E

3ORRFF

ELEBLB

LALNAONIOTIS

A

0OM

90 43OM

ARCIMn ottuh bsu• Psleehy woll• Atnoe ctamil• C

htooteul• B

SSINHex

NISSSSH

IA Ttrats

C/l Aort

H

$

SAQNASWOE NREHL

4,16

An DUoitarent Gex

AAN Q SSHAAASASQQAQASSSASAHERE N WWOOOWOW

I

0AQH

!WS

94YAYWE AVIRD

RTe

Xellbbaalliiav• A

h ctarc• Soe csiur• C

e sreve• R

IL

HQAIQQAQAW!

Ty

L SIARyaallppssiiD dD dCCL LL • L55.r 2r 2L oL o00.n 2n 2e ie i

w$

od rnoceg snidilt • Sniad pleihsytivitcennoe cnoht praml • Sortno

tratn sottuh bsua • Premac

$33

00990 4V

33YAYWE AVIIRRDD

0,4

t

3ef

r

.A. COM

otinow meid vnuory • Agolonhcey t

tsissk arat pnegilletns • Ithgig lni

ytivitcennoe cnoh

snoitpl oeseid dnl aor

$

P.9% INFEN SO

2RT FS

0

MPARISON RATE

9

†ECNANLEDOD MTECELE

99 IVE8,2M

RDYAWAY

OR

ES

0

tid wilad vaPe ilppe AerF*rel paunn% a9.d 3na

e itan rosirapmocaler reffs oihtwardhtiw

3.

02 8884 4477

h

| 37

. T410, 2tsuguf At os1t - 3se 1hn teewted bereviled dnd aloe slcihey vrevh etAs (ecivrel Saicnanin Fassif Ns otnacilpps asenisud bevorppr aoe ftae rgatnec

. Dsegrahd cns aeel fle adulcnt ioy nad mnn aevie glpmaxe ehr toy flne ours til maunaT me Skud Jliu3 b10w 2en nd oilar veff. Oylnm oreh ttno6 mo a 3s tetas ereffr oehtl ol. Ar.effr oehty onh atin woitcnujnon ce ilbaliavt ao. Nreffs oiht

9. EN SOTAT3 P01• 2TL3 A01• 2

Blacktown Road

l

| BlaSISN

iavt ao. Nr.effr ooe flbigile eo be tsahcruf pe omit td aetnesere pt bsud ms aihatne, Rtnemnrevos Gedulcx. Eyln) o46419r 3ebmue Ncnecit Lidern CailartsuArapmot cnereffin a dt iluset rhgis mtnuomn aaor lehtr os oee, fsmret tnereffiledoo mtuD aWT 2r Sednfihtaw Pe, nsledoo mtuT aa Smitld Aliu3 b10, 2sledom

8454AP5 Y0302D. M41/8/1d 3n

LEDOD MTECELEEKU3 J01R • 2EDNIFHT

Z07A • 3MIT

acktownNAS

hsar coe flbameedet ro. Nsreffr oehty onh atin woitcnujnon ce ilbano. CRP% A9.. 3shtno6 mf 3m orem tumixa. Msremotsut ceell Fanoitad Nnl aa

sas be idot Ciderl Canoitae Nhf te osoprue phr toe ftan rosirapmo. Cetan rosi/0d 3n4 a1/7/n 1eewted bereviled dnd aeredrs oledol maunae mpuoz C07, 3s

LS

% c

sih: TGNINRA. Wylpps aegrahd cns aee, fsnoitidnhguohtl0 a00,03f $n oaod lerucer saen a 5 yd oe

rd onetx, eyrao vt thgie rhs tevresen rassi. N41/9/

ppd pppp

YONLLY4 MINS FROM

PROSPECT HWYTURN OFF

ON THE M4

.landewww

ernissan.com.au

u

ahg

.com.au

Consider our product disclosure statement before making a decision about First State Super. Call us or visit our website for a copy. FSS Trustee Corporation ABN 11 118 202 672 ASFL 293340 is the trustee of the First State Superannuation Scheme ABN 53 226 460 365.

At First State Super we believe Australians who choose careers looking after others

LAM

_Car

ing4

Peop

leW

hoCa

re_2

75x2

00_1

113

Date post:	01-Apr-2016
Category:	Documents
Upload:	the-lamp
View:	240 times
Download:	6 times

The Lamp August 2014

Documents