Published on March 10, 2014
Australia independe ’s nt voice of nursing Issue 1 February 2013 www.nursingreview.com.au Spotlight on specialists Leaders show support Men’s health Why are women living longer? Patients welcome hospital in the home
2012 winners, left to right: Brenden Stapleton, Jenny Anderson and Nicholas Ralph Know someone in nursing who deserves an award? Recognise their outstanding leadership and innovation by nominating them in one of three categories: Nurse of the Year Team Innovation Outstanding Graduate $30,000 c ckEs E titikEt ts N s s lE ooN aal NoW NoW N om i N NomiNa NoW!atE No NNomn omi in W! aai t 228 Fe tonsscclose 8 Febbu ion los e r ruary2 ary 20 013 13 in prizes to be won!* Winners announced at the awards dinner on Thursday 9 May 2013, in Melbourne. *Generously provided by: Proudly presented by: Visit hestaawards.com.au for more information. hestaawards.com.au Issued by H.E.S.T. Australia Ltd ABN 66 006 818 695 AFSL No. 235249 Trustee of Health Employees Superannuation Trust Australia (HESTA) ABN 64 971 749 321. 2 | February 2013
contents EDITOR Amie Larter (02) 9936 8610 email@example.com production manager Cj Malgo (02) 9936 8772 firstname.lastname@example.org CHIEF SUBEDITOR Richard Jenkins (02) 9936 8643 email@example.com National SALES manager Gillian McCaughey (02) 9936 8607 firstname.lastname@example.org SUBSCRIPTION INQUIRIES (02) 9936 8666 email@example.com ACN MEMBERS ADDRESS CHANGE firstname.lastname@example.org 1800 061 660 PUBLISHED BY APN Educational Media (ACN 010 655 446) PO Box 488 Darlinghurst, NSW 1300 ISSN 1326-0472 PUBLISHER’S NOTE © Copyright. No part of this publication can be used or reproduced in any format without express permission in writing from APN Educational Media. The mention of a product or service, person or company in this publication, does not indicate the publisher’s endorsement. The views expressed in this publication do not necessarily represent the opinion of the publisher, its agents, company officers or employees. 10 clinical practice 26 Hospitals in the home news 04 Creating graduate positions An acute care alternative Forecasting for the future workforce 28 Opinion 06 Limiting access to care The role of acute care in mental health Health service turns patients away 29 Men’s health 08 ANMFSA joins group petition Getting blokes to talk about it SA nurses contest McCann review 10 Patient participation in care New research into preferences policy & reform 12 Specialisation 29 workforce 32 Looking after yourself Tips to tackle the year ahead 34 Have your say Peter Kieseker on aged care nursing Is it deskilling the workforce? 16 Climate change 35 Q&A with Molly Carlile Preparing for future health issues Career, passion and awards 18 Tasmania troubles legal column 36 Anorexia nervosa Budget cuts hit specialty focus 20 Practice nurses Advancing holistic care Audited 15,635 as at Sept 2012 16 12 24 Community nursing Our health system’s silent crisis Courts face legal and ethical dilemma 32 technology 38 vetAWARE course Mental healthcare for veterans If you want to change lives, it’s time to change yours. The Australian College of Applied Psychology offers courses in counselling, psychology, case management, coaching and people management with flexible study options to fit in with your life. Our counselling degrees are PACFA accredited and our psychology courses are recognised by APAC. You get individual attention with our small class sizes and practical learning from our teachers who are professionals working in the industry. It’s time to stop thinking about your dream job and do something about it! FEE-HELP available Visit our website for information session details. acap.edu.au | 1800 061 199 ACAP is a Navitas Professional college. CRICOS Codes NSW 01328A, QLD 02565B, VIC 02829E. RTO number 0500. www.nursingreview.com.au 2761-0113 February 2013 | 3
news Grads f ock to l By Amie Larter P lanning and forecasting for the future workforce should be a nationwide focus to protect the needs of our graduate nurses, says Professor Ged Williams, executive director of nursing and midwifery at Gold Coast Hospitals and Health Service. As the ANF’s “Stop passing the buck, Australia’s nursing grads need jobs” campaign reaches full swing with more than 2650 emails to politicians, Gold Coast Health (GCH) is using a different approach to ensure future graduate placements. GCH has taken on more than 25 per cent of the total graduate placements allocated by Queensland for 2013 – 138 graduates in January, with an expected 30 to 40 more to come on board midyear. This is an increase from last year, where the total intake was 120 students. Williams suggested this success was due to planning, and that a planning framework and strategic initiatives needed to be applied at a district, state and national level. “The community cannot afford for all these graduates to not work this year. Because if they do not work this year – they are highly unlikely to come back into the industry and we are going to lose them for good. What’s lacking is a sense of urgency and a sense of proper measurement to inform the decisions that need to be made,” he said. The team at GCH uses an in-house designed commercial workforce planning tool WorkMAPP, as well as electronic roster system, eRoster, to effectively manage workforce supply and demand equations that inform both long-term and short-term staff planning respectively. “Using WorkMAPP, we can model different scenarios like a high attrition rate, nursing shortage, or any other situation that would increase service requirements,” said Williams. “We put the information into the tool and it calculates how many nurses we might require at different levels across the district in the outgoing years.” The team uses the eRoster tool to gain retrospective data on patterns of sick leave and resignations throughout the year to ascertain when you are more likely to need and or lose more nurses. This information is then applied to prospective forecasting. “If we know we get a large number of resignations in October or November or if we had a high sick leave rate in August – next year when we are planning our 4 | February 2013 Protecting nursing’s future: Stacey Pickering is one of the many graduates heading to Gold Coast Health. workforce requirements we make sure we have buffers lined up for those particular periods. Such patterns are likely to be seasonal, and to an extent predictable,” Williams said. “These two tools are working hand in glove to give us a really good understanding of how our workforce moves and changes over time, so we can re-forecast what our requirements are.” Data is extracted from the tools and GCH then works collaboratively with universities and other service providers to align what they deliver to create the appropriate amount of opportunities for students once they have completed their studies. Professor Jenny Gamble, acting head of school at Griffith University’s school of nursing and midwifery, believes that GCH is one of the most innovative districts in relation to workforce planning. She said their collaborative approach allows the university to hear and respond effectively to the needs of the industry. “This kind of approach allows us to be much less reactive,” she said. “We don’t get caught up in that loop of changes in the industry that require sudden tertiary response.” This system also allows students to focus their study and energy on areas of future need for the hospital. “Forward planning identifies a gap and students know they will be able to profile themselves strongly,” Gamble said. “This gives them the cutting edge around employment because they can then target their study to identified work gaps.” GCH also has also implemented a roster where graduates are only on for three days a week – which means that they have only 86 full-time positions available, however, they have a head count of 138. “We are accepting 138 graduate nurses and midwives working three days per week on a 12-month temporary contract. There is a vulnerability for this year’s graduates that at the end of 12 months if they do not secure a permanent job with us, then their employment will cease, to make room for next year’s graduates,” explained Williams. “Our current retention rate following the graduate year is 95 per cent.” Of the 119 graduates employed in 2012, 117 are staying on beyond the completion of the program. “The benefit is, they have 12 months of employment, they have consolidated their training and they are now competent RNs,” Williams said. “Even if we can’t employ them, they will be much more employable.” Gamble confirmed that students understand that it is a tight market, and even though many would prefer fulltime employment, they are delighted and grateful to have a three-day a week position. “Many are very amenable to the idea that they and their peers get three days a week rather than a whole lot of people missing out because a few people get five days a week,” she said. n
s 4 0 en t e r e v a ll y O v n a l n nu t io a na held news Last year 3148 Australian Nurses trusted us to deliver their Professional Development Points 2013 Q1 Event Schedule • Clinical Documentation, Coding & Analysis Conference 18 – 19 February 2013 | Hilton on the Park Melbourne • Medico Legal Congress 21 – 22 March 2013 | Sydney Harbour Marriott • National Dementia Congress 21 – 22 February 2013 | Novotel Melbourne on Collins • Developing the Role of the Nurse Practitioner Conference 21 – 22 March 2013 | Novotel Melbourne on Collins • National Forensic Nursing Conference 21 – 22 February 2013 | Radisson Blu Plaza Hotel Sydney • Hospital Patient Costing Conference 21 – 22 March 2013 | Stamford Plaza Brisbane • Hospital Bed Management & Patient Flow Conference 25 – 26 February 2013 | Novotel Melbourne on Collins • Mental Health Units Conference 25 – 26 March 2013 | Marriott Melbourne • National Telemedicine Conference 20 – 21 March 2013 | Pullman Hotel, Hyde Park Sydney • Electronic Medication Management Conference 25 – 26 March 2013 | Hilton on the Park Melbourne Acknowledging the quality of our conference programs and demonstrating our commitment to professional development and excellence in nursing. IIR Conferences proudly holds Royal College of Nursing, Australia APEC (Authorised Provider of Endorsed Courses) status. (APEC number 090810001) www.healthcareconferences.com.au www.nursingreview.com.au February 2013 | 5
news Qld hospital S 10pm SHUT-OUT taff at a Brisbane hospital have been instructed to turn away patients presenting after 10pm, with management guidelines suggesting nursing staff offer sick patients a “blanket and pillow”. Nurses and other health professionals at Wynnum Health Services, formerly Wynnum Hospital, have been told that patients presenting between the hours of 10pm and 8am should be treated outside the facility until an ambulance arrives – including those in life-threatening situations. The guidelines from Metro South Health (MSH) go as far as to state “if BLS [basic life support] is required commence BLS at the front door.” Dr Rosalind Crawford, MSH director medical services and facility manager Redland and Wynnum hospitals, said the decision to deny after-hours access was first enforced due to staff and patient safety concerns, and that the staff’s main priority was the patients in the 21-bed ward. She said the majority of patients at the hospital were frail and elderly and should not be left unattended. However, Des Elder, Queensland Nurses Union assistant secretary, believes this puts nurses in an untenable situation of having to assess patients without any medical officer support or necessary equipment. “This means they are torn between their duty of care to the patient and their professional obligations to work within their scope of practice,” Elder said. “Clearly requiring staff to perform BLS at the front is what is expected. This is clearly an inappropriate and dangerous requirement. The guidelines are unreasonable and seek to transfer the risk and liability from the health service to the individual nurse and patient.” Local residents plan to once again make their voices heard, Elder stating that the community does not accept the “spin” from the board as to why the emergency service was axed in the first place. “It is on the public record that the hospital board believes the service should be provided by the private sector. It is a plan to slowly privatise health in the area. It is another example of the ham-fisted and disgraceful way the government is handling health services,” Elder said. MSH has confirmed that the directive is now under review. n The dressing protector that keeps wounds dry while showering For those who care about how their home looks Keep-Dri Dressings An effective solution to wound management and infection control in the hospital and home. Rectangle protectors available in four sizes – Perfect for small to large wounds, catheters, hip replacements and drainage sites. Bag protectors available in two sizes – Perfect for leg and arm casts, knee replacements and varicose veins. For many years CareWell Health has been helping people choose better equipment and furniture • • • • Waterproof and hypoallergenic Ready made Simple to use Benefits nurses, patients and hospitals • Time and money saving The people we have typically helped were worried about the look of their care home; irritated by damage done to the walls; sick of maintenance not done or repairs dragging on; and worried about getting value for money. We can help you make your residents feel more at home Model shown here is the Freya in beech veneer. For further details please contact our toll free number or email. Toll free 1800 30 32 88 6 | February 2013 email email@example.com ABN 92 347 834 602 002 Australian owned and manufactured T +61 8 9271 4844 F +61 8 9271 4846 E firstname.lastname@example.org www.nursinginnovations.com.au
Breast cancer help Birth trauma for fathers • With breast cancer causing the second highest number of deaths in Australia, patients in regional cancer centres and metropolitan areas will now have access to specialist breast care nurses after the federal government committed a further $18.5 million to the McGrath Foundation. The funding will allow the program to continue and expand from the current 44 existing nurses to add the equivalent of 10 full-time positions. • The University of Western Sydney’s school of nursing and midwifery will investigate a new side of traumatic births – looking at the impacts on male partners. Researchers will explore men’s experiences of labour and birth where the partners have experienced complications or needed urgent intervention. About 295,000 babies are born in Australia every year and principal researcher Dr Rakime Elmir hopes that the findings of the study will help create greater awareness among health professionals, particularly midwives and child and family health nurses, of the support needed for men following a traumatic birth. WA nursing shortage Community package help • According to a major survey conducted by the Australian Nursing Federation, WA will face major shortages with only about 44 per cent of nurses planning to stay in the industry for longer than a decade. In addition, almost 36 per cent of nurses said they experienced regular shortages, while nearly 16 per cent said the shortages were getting to dangerous levels. Describing the results as alarming, Mark Olson, ANF state secretary, called for the government to act quickly to retain and attract more staff with better pay and conditions. • Among other providers, Care Connect has recently been awarded a ComPacks (Community Package) contract – a NSW Ministry of Health initiative to minimise the risk of hospital readmissions. The service will allow appropriate patients to be supported for up to six weeks in an early transition home – helping to free vital beds in the state’s public hospitals. Care Connect will be responsible for delivering the program to 5000 patients in six local health districts, providing much needed non-clinical community support to people after they leave hospital. 4th Annual Clinical Documentation, Coding & Analysis Conference February 18 to 19 Hilton on the Park Melbourne www.healthcareconferences.com.au Strategies and solutions for improving clinical documentation, coding and analysis in the ABF environment calendar inbrief news 4th Annual National Dementia Congress February 21 to 22 Novotel Melbourne on Collins www.healthcareconferences.com.au A national event examining dementia care issues from diagnosis through to palliation, exploring the theme of doing things differently in dementia care. National Forensic Nursing Conference February 21 to 22 Radisson Blu Plaza Hotel Sydney www.healthcareconferences.com.au The only national event of its kind promoting research and leadership for Australia's Forensic Nursing Community 6th Annual Hospital Bed Management & Patient Flow Conference February 25 to 26 Novotel Melbourne on Collins www.healthcareconferences.com.au Australia's foremost patient flow improvement conference, showcasing innovative case studies and pioneering best practice in the nation’s hospitals ADVERTORIAL Don’t give your money away, roll over! You’ve earned your super so, when the time comes, make sure that you get to enjoy every cent of it. This means making the most of what you have. One of the ways you can do this is to make sure you have only one super account. That’s because super funds charge fees. So, the more accounts you have, the more fees you’re likely to be paying. 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This is very important to protect your super account(s) and to ensure that there isn’t a delay in processing your request. Details about acceptable ID and those people who are authorised to certify documents are outlined in the rollover form. For more information on HESTA, your health and community services industry super fund, visit hesta.com.au or free call 1800 813 327. 4Fill in the form Download a rollover form at hesta.com.au/consolidate or free call 1800 813 327 for a copy. This material is issued by H.E.S.T. Australia Ltd ABN 66 006 818 695 AFSL No. 235249, Trustee of Health Employees Superannuation Trust Australia (HESTA) ABN 64 971 749 321 . Information provided is of a general nature. It does not take into account your objectives, financial situation or specific needs. You should look at your own financial position and requirements before making a decision and may wish to consult an adviser when doing this. This information contains H.E.S.T. Australia Ltd’s interpretation of the law but should not be relied upon as advice. For more information, free call 1800 813 327 or visit hesta.com.au for a copy of a Product Disclosure Statement which should be considered when making a decision about HESTA products. www.nursingreview.com.au February 2013 | 7
news Taking money out of primary and preventative care will cost more in the long term, say nurses and health advocates. SA $14m cut ‘short-sighted’ L eading South Australian health groups have joined forces to launch a petition against recommendations for cuts made in the McCann review of non-hospital health services. SA Health appointed Warren McCann, internal consultant for the Office of Public Employment and Review, last August to undertake the review. More than 100 jobs and a range of different health programs and services are in the firing line, in a move which the review suggests will save about $14.6 million. The Australian Nursing and Midwifery Federation (SA Branch), SA Council of Social Service, Health Consumers Alliance of SA, the Public Health Association and the Australian Health Promotion Association have joined forces to fight recommendations they describe as “short-sighted” and “not based on sound evidence”. ANMF state secretary Elizabeth Dabars said the recommendations contained in McCann’s review are entirely at odds with international research and the Menadue Generational Health review, which emphasises the need for investment in preventative and primary healthcare and was adopted and is in current state government policy. 8 | February 2013 “If you can address issues now, then you can address the long-term costs of healthcare by intervention sooner rather than later,” she said. “This goes back to the basic principle that prevention is better than a cure.” The groups believe that McCann’s approach will increase the burden on an already overstretched hospital system. Rather than strip money away from primary healthcare, they suggest putting more investment into it. “We can save money at the other end – which is not having people lining up at the emergency department which is a very costly exercise,” Dabars said. “As an example, if you have people that do become obese and morbidly obese – the cost to the system is significant. You have to buy additional infrastructure, beds, wheelchairs and you would need additional staff. “Rather than having one nurse at a time you have to at least have four people just to assist them with their basic care needs. “This is going to be a significant cost to the public and one that is much better avoided.” Dabars said the community will be the emotional and financial beneficiaries of a health system where investment is based on promotion and prevention, and it is up to the SA health professionals and community to make it happen. “As health professionals we are advocates for our patients and really part of our advocacy should always be trying to avoid people from becoming patients in the first instance. “I see the role of nursing and midwifery at this point to be part of that advocacy and as result I would encourage anyone in the nursing and midwifery professions to sign the petition but also encourage their family and friends and loved ones to also sign,” she said. SA Health said the review “supports a number of new recommendations which constitute significant reforms to the delivery of some non-hospital based services” and that a two-month public consultation on these services and strategies is currently underway, concluding on February 4. The department said it welcomes and encourages all feedback as part of this process and “will consider all feedback on the new recommendations before finalising a proposed response to the report for government’s consideration”. n
news SAVES MORE PBS Information: This product is not listed on the PBS. XYNTHA is funded by the National Blood Authority for haemophilia A patients. Please refer to the National Blood Authority for details. THAN BEFORE PRESCRIBING, REFER TO THE FULL PRODUCT INFORMATION AVAILABLE AT WWW.PFIZER.COM.AU TIME Minimum Product Information. XYNTHA® moroctocog alfa (rch) 250, 500, 1000 and 2000 IU powder for injection vial. moroctocog alfa (rch) 250, 500, 1000, 2000 and 3000 IU powder for injection in a prefilled syringe*. Indications: Control and prevention of haemorrhagic episodes in patients with haemophilia A. Contraindications: Known history of hypersensitivity to any of the constituents or to hamster proteins. Precautions: Factor VIII inhibitors (neutralising antibodies); less than expected therapeutic effect; when switching between factor VIII products monitor plasma activity and clinical response, and titrate therapy, as potencies may differ; allergies; pregnancy: category B2; lactation; paediatric use. See full PI for details. Adverse Effects: factor VIII inhibition, headache, vomiting, anaphylactoid reaction*, neuropathy, haemorrhage/haematoma, angina pectoris, tachycardia, dyspnoea, lab increase for antibody to CHO protein*, lab increase of FVIII antibody*, others – see full PI for details. Post marketing reports of high titre inhibitors developing in PTPs*. As with any intravenous protein product, allergic type hypersensitivity reactions are possible. Dosage and Administration: Complex, see full PI for detailed dosing instructions. *1,2 * syringe eliminates transfer between vial & syringe for ease of reconstitution1,2 *PLEASE NOTE CHANGES TO PRODUCT INFORMATION. References: 1. Xyntha® Australian Approved Product Information. 2. Westfeld M. et al. Haemophilia 2012; 18 (Suppl. 1): 30-31. P6775 October 2012 Pfizer Australia Pty Ltd, 38-42 Wharf Rd, West Ryde, NSW 2114. www.nursingreview.com.au moroctocog alfa (rch) recombinant coagulation factor VIII 250IU 500IU 1000IU 2000IU 3000IU Available in a range of dosing options For control & prevention of bleeding in haemophilia A1 February 2013 | 9
news Patients urged to get involved A joint university research project will examine the success of encouraging patients to have more of a say in their care. Amie Larter reports P atient participation in care (PPC) is not a new concept, however, little research has been done in Australia into how hospitals would deliver changes, and whether patients are ready and willing to participate. The World Health Organisation as well as the Australian Commission on Safety and Quality in Healthcare have been long-time promoters, and recent statistics suggest that this could decrease the rate that patients pick up a secondary illness or injury in hospital. An Australian Research Discovery grant has recently been awarded to Griffith University’s National Centre for Research Excellence in Nursing (NCREN) and Deakin University to explore patient and nurse responses to PPC and their willingness to participate in it. “The first phase is exploratory, and we will find out from nurses and patients what they think of active participation in their care,” said Professor Wendy Chaboyer, director of Griffith’s NCREN, who will lead the three-year study. “We want to find out what nurses think, as we would like to understand some of the barriers and drivers for this actual participation because it means a power 10 | February 2013 sharing.” Chaboyer said patients will now be acting as partners in their care. The second phase, led by Griffith health economist Dr Jenny Whitty, will be an experiment where scenarios will be presented to nurses and patients to explore preference in care. Results from this will be used in the third phase to develop recommendations on how hospitals might be able to have patients participate more actively. The Australian Nursing Federation federal secretary, Lee Thomas, said that nurses try to promote a positive therapeutic relationship using effective communication and advocating for patients. This demonstrates their support for patients making decisions about their own healthcare management. “Patients need to believe that they can ask questions and feel confident they understand the answers they are given. By providing empowerment, nurses encourage people to choose and negotiate about their care and take the lead in decision making.” Thomas suggested that in order for nurses to build upon the PPC approach, they would need time to educate patients – something that was not always available within an acute setting where patients have relatively short stays. “They need the staffing and resources to do this. Shared decision making and working in partnership with people is important in ensuring a fairer service. “A PPC approach has great potential and it is our hope that the research will demonstrate whether it will improve patient care and the resources required to achieve this,” Thomas said. International research suggests that nurses’ responses to the PPC approach have been varied. “Some nurses feel threatened and challenged if patients speak up,” Chaboyer said. “On the positive, from these small studies, some nurses embrace patients participation; they value it and see its importance, thus are dedicated to supporting patient participation. “However, nurses report they still need to maintain some control,” Chaboyer said. n
news www.nursingreview.com.au February 2013 | 11
policy & reform Educators specialisation 12 | February 2013 o • cardi • em erge n l he ent a ae dic/s p i rth op • o urg ica l /s periopera t i ve Considine believes it was inevitable that the medical profession would become more specialised as medical research revealed more details about particular illnesses and diseases. The more complex a sickness, the more it requires each area within the medical profession to have greater knowledge and that invariably leads to specialisation. “If I had a cardiac arrest, I would want an expert emergency nurse, if I was having a baby, I would want an expert midwife, if I've had a stroke, I would want an expert stroke nurse,” Considine says. “No one ever suggests that orthopaedic surgeons take over the plastic surgery list.” General medical training has advanced greatly in all areas since Considine started out 30 years ago. “When I trained in the late 1980s, there were still general medical and surgical units, but it was common for surgical specialties to be clustered on the same wards like plastics, orthopaedics, gastrointestinal,” she says. “Now medicine has also sub-specialised and your find medical units with specific expertise in stroke, respiratory problems, diabetes and new areas are developing too. There are many benefits to nurses specialising … such as patients receiving expert care in that area and the nurses can help out with answering questions, thereby comforting the patient. “It improves the outcome for the patient and specialised nurses might notice something that a general nurse doesn’t. A patient may have broken his or her leg and that is what they are treated for. A nurse who may have worked with stroke victims would naturally look to see if there was any head trauma rather than just treating the immediate injury. “Of course, there can also be some disadvantages to nurses specialising as it can lead to a less flexible workforce and nurses might become deskilled in areas other than their cy a lth Complex illnesses •m A s a patient, we are both relieved and fraught with nerves when we are told we need to see a specialist doctor. Relieved that there is someone in the field of the unknown illness that our body is carrying, which eases our mind that a cure may be found sooner rather than later. We are also very nervous that something may be seriously wrong with our health and it may result in a prolonged illness or even death. It is as if our body and feelings are facing a dichotomy. But where there remains hope, which will always prevail when we know there is a specialist doctor in the field of illness for which we are currently diagnosed, the more positive feeling will generally win through. While patients take comfort in seeing a specialist doctor, there are mixed feelings within and outside the nursing profession regarding more nurses specialising – in fields such as emergency, aged care, coronary care, midwifery, oncology and palliative care amongst others. Some see this as a negative, resulting in nurses losing general skills and unable or unwilling to transfer their skills to another section of the hospital or to a completely different area in nursing. This is because of the difficult processes involved in applying for another job, such as getting the required police and reference checks, interviews and preparation. However, others see it as a positive. “I have never heard anyone complain that we have too many specialist doctors,” says Julie Considine, professor in nursing at the school of nursing and midwifery at Deakin University. “So, I am not sure why people would complain about there being too many specialist nurses? l “Nurses have always specialised but I know a lot of nurses that transfer their specialist skills. For example, I have emergency nursing colleagues who now work in ICU and hospital in the home and they have benefited from the experience. “Personally, I have always worked in emergency care and relished the challenges that it presents.” n al Letting too many nurses concentrate on narrow areas of practice depletes the number of general duties staff, say critics. But educators argue that medical advances make it necessary. Louis White reports
c om m un i an ag e r •m in t ty si n g e nsiv e care • n t na • al n ur eo policy & reform • b r ig o og a y• in c ag e d al • are ed er • i t ion ra ct • p uc ator • re h i ab l it a e dia • pa fery i d wi •m t io n t ri c www.nursingreview.com.au speciality, which means hospitals have decreased ability to move nurses within their organisation. But I don’t see any of these conversations happening about medical specialists!” The Nursing and Midwifery Board of Australia says there are just under 337,000 registered nurses and midwifes in Australia as of September 2012. There about 238,000 registered nurses, 59,000 enrolled nurses and 33,000 registered nurse/midwives. These are the three largest categories in the profession. The biggest worry for Australia is the age of nurses. There are 51,055 nurses and midwives in the 51- to 55-year-old category. In the 41- to 60-year-old bracket there are a total of 178,567 nurses and midwives. Surveys conducted by Monash University, Health Workforce Australia and the Australian Nursing Federation indicate that more and more nurses are looking to leave the profession for a multitude of reasons, including poor pay and lack of career opportunities. Career progression By creating more and more specialist nurse roles it increases the opportunities for nurses to gain broader skills, higher pay as well as more job satisfaction. “There are often better career progression opportunities for specialist nurses,” says Dr Colleen Smith, associate head of the University of South Australia’s school of nursing and midwifery. “For instance, nurses with specialist qualifications can extend their scope of specialist practice by undertaking the Master of Nursing (Nurse Practitioner) program. By offering specialist nursing positions, nurses can undertake that option and study the necessary qualifications to progress in that field.” Smith believes there are far more advantages than disadvantages to nurses being able to specialise and it was inevitable that this genre would open up due to medical research. “Nurses specialising in particular areas of medicine is a response to an increase in technology and advances in medical and health care knowledge,” she says. “Patient care is much more complex resulting in the need for more specialist nurses to drive the safety and quality agenda and improve patient outcomes.” The reality is that we are an ageing population. The Australian Bureau of February 2013 | 13
policy & reform Statistics states that 13.5 per cent of the population are currently aged over 65 years. By 2050 this age group will make up almost 23 per cent of the population. There will be just 2.7 people of working age (15 to 64 years old) compared with five now for each Australian aged 65 years and over. The risk of having a stroke rises as you get older. Australians are exercising less, eating more junk food and obesity is on the rise, meaning that diabetes will only increase. As we get older more illnesses and injuries occur and each year medical research makes discoveries resulting in new diseases coming to the fore requiring more specialist knowledge in that area. This will flow from what children are immunised with to the way people are treated in hospital to the design and care of patients in hospitals in the future. “The advantages of nurses having specific knowledge is that they acquire in-depth knowledge and skills in their specialist area of practice and provide advice and support within their specialist scope of practice to other health professionals,” Smith says. “Of course there is the disadvantage of specialist knowledge and skills not readily transferrable to other areas of nursing practice, so this could result in the potential to lose skills. “Overall, their needs to be a sufficient mix of generalist and specialist nurses to ensure a flexible workforce that caters for the needs of the healthcare industry.” Thomas Harding, professional officer at the NSW Nurses and Midwives Association, believes that it has always been a trend for nurses to find a niche and stay there. “I don’t think it is that different from other professions, where you find a niche within your field of expertise and choose to remain there,” Harding says. Technological advances This school of thought is backed up by the Australian Nursing Federation federal secretary, Lee Thomas, who says that like all occupations some nurses choose to stay in a particular area for many years of their working life. She says this choice is not unusual and is made generally because of the preference for that type of nursing. “Skills are broadened and many new skills learned over the years, as medical technology and techniques change. But nurses remain nurses with broad skills irrespective of the areas in which they might choose to spend their working life. 2013 Course Calender The “ALERT” COURSE (TM) Acute Life-threatening Emergencies, Recognition & Treatment. Melbourne: 3rd & 4th May 2013. Sydney: 12th & 13th July 2013. Perth: 26th & 27th July 2013. Brisbane: 13th & 14th Sept 2013. Adelaide: 26th & 27th September 2013. Newcastle: 29th & 30th Nov 2013. ANAESTHESIA & POST ANAESTHESIA CARE NURSING SEMINAR Melbourne: 21st & 22nd June 2013. Brisbane: 19th & 20th July 2013. Perth: 6th & 7th September 2013. Sydney: 22nd & 23rd November 2013. “However, nurses in rural and remote areas, working in the outback and in small country hospitals don’t have the same opportunities to stay in one area for many years,” says Thomas. Harding, however, points out that the general public fails to differentiate nurses like they do with doctors. “Most patients just see a nurse as a nurse,” he says. “That is unfortunate in that all nurses should be recognised for the skills that they bring on board and specialised nurses do extra study and training.” He does agree that processes in place within the healthcare sector don’t make it as easy as once before for nurses to chop and change their career path. “There is no doubt that through all the processes in place these days it is harder for nurses to move from one area of specialty to another or even back to a general nurse once they have specialised,” Harding says. “The reality is that in the future we will need more specialised nurses due to the advancements in medical technology. Doctors too want more specialised nurses to work with. “While this benefits the city we also need to take into consideration that in CRITICAL CARE EDUCATION SERVICES Pty. Ltd. 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policy & reform the country, with less medical assistance available in all areas, we need more general specialised nurses.” Harding, who previously held a senior position at the Australian Catholic University, says that undergraduate and postgraduate degrees have developed substantially and offer more comprehensive learning, enabling students to better demonstrate their skills and knowledge. “Nursing degrees offer greater flexibility and improved learning facilities thereby enabling students to have increased knowledge. “The result of that is students will then want to know more about speciality and there are greater opportunities for them now to undertake such post-graduate courses and training than there has been in the past. “Of course, this is all determined by labour market activity but the greater skillset one possess the more opportunities afforded to them. “I don’t believe nurses lose skills if they specialise, they just acquire new ones and that is to everyone’s benefit.” Professor Ramon Shaban, deputy head of school of nursing and midwifery at Griffith University, actually believes there is less specialisation now than in the past. Nurses have always specialised but I know a lot that transfer their specialist skills. I have emergency nursing colleagues who now work in ICU and hospital in the home and they have benefited from the experience. “I don't know that I believe that nursing specialisation is more common,” Shaban says. “Specialisation has been [this way] for many years, and in fact to some extent there is less specialisation. “Generally speaking, the growth of some specialty areas of practice has been supported by research and evidence-based practice, along with the move of nursing education from the vocational sector to the tertiary sector. These have afforded the development of specialist, research and evidencebased practice. There is a need for the specialist-generalist.” Shaban says that specialisation offers mastery of skills, professional standing, expert patient and practice care and flexibility for nurses. “Increasing specialisation, and multiple specialisation, increases professional portability and employment,” he says. “In addition, nurses change and expand specialisation as their careers evolve, as their personal circumstances change. “To some extent they lose skills, but they gain others. Their skill and expertise evolves – evolution is the best way to describe it. All skills and abilities acquired are relevant to future practice and specialisation. It adds to the individual's practice base. Specialisation is fundamental and important.” Expect more of the specialised nurse and less of the generalist nurse in the future, though both are needed all around the country. The more money, effort and time invested into medical research means more discoveries and more knowledge acquired. We all take relief when we hear that a specialist doctor is available, perhaps we should start doing the same with specialist nurses. After all, we generally end up spending more time with them than the doctor anyway. n How does your fund compare? When comparing funds, make sure you have all the facts before you decide. Not all super funds are the same – know your apples from your oranges. Our fund offers: U U U U U Low fees Commission-free ﬁnancial advice 12 investment options – including two SRI options Income stream options for income in retirement You’ll join one of Australia’s largest funds with over 770,000 members Call 1300 650 873 Visit www.ﬁrststatesuper.com.au Email enquiries@ﬁrststatesuper.com.au This advertisement contains general information only and is issued by FSS Trustee Corporation (ABN 11 118 202 672, AFSL 293340) as Trustee of the First State Superannuation Scheme (ABN 53 226 460 365). Any advice it contains does not take into account your speciﬁc objectives, ﬁnancial situation or needs. Consider the Product Disclosure Statement available at www.ﬁrststatesuper.com.au or by calling 1300 650 873 before making a decision in relation to your membership. Financial planning services are provided by Health Super Financial Services Pty Ltd (HSFS) (ABN 37 096 452 318, AFSL 240019) trading as FSS Financial Planning (FSSFP) and Health Super Financial Planning (HSFP), which is wholly owned by the FSS Trustee Corporation. HSFS is responsible for the advice they provide. November 2012. www.nursingreview.com.au February 2013 | 15
policy & reform Dealing with climate change The effects of a warming planet may already be on us and nursing courses need to prepare graduates for the health issues to come. By Liz Hanna T he Australian Senate is running an inquiry to examine “Recent trends in and preparedness for extreme weather events”. Calls for submission closed on January 18. Our politicians are clearly concerned about Australia’s preparedness. This is a call to arms for the health workforce to step up and prepare. A new world is bearing down upon us in the form of new climate frontiers. Following the unheralded fire conditions of Black Saturday, in February 2009, fire authorities were obliged to add in the new category of “Catastrophic” to accommodate the increased intensity we are now seeing in fire conditions. In January this year, the Bureau of Meteorology added two new colours – deep purple and pink – to the interactive weather forecasting chart to extend its previous temperature range. Once capped at 50 degrees, the bureau needed to extend its capability to 54°C, to accommodate these new heat extremes that are now occurring. Also in January the average maximum temperature across Australia peaked at 40.3°C, a new record, and it remained over 39°C for seven consecutive days, twice as long as the previous record. This follows a warm end to last year, where for the last four months, the average 16 | February 2013 Australian maximum temperature was the highest on record with a national anomaly of +1.61°C, from records dating back to 1910. On January 4, Hobart reached a maximum of 41.8°C, breaking a record held for 120 years. We must face it, the world is warming. Heat extremes are an increasing global phenomenon. Last year was the warmest on record (since 1895) for the 48 contiguous US states. The 2011/12 winter season was nearly non-existent for much of the eastern half of the nation. 2012 was, for the US, the second-worst for weather extremes including drought, hurricanes and wildfires. In addition to the summer being hot, it was also dry, resulting in a drought footprint comparable to the drought episodes of the 1950s. These aberrant weather patterns are being experienced all across the globe. Heat extremes which were once at the frequency of 0.1 per cent of the time are now coving 10 per cent of the planet at any one time. Extreme weather events have increased three fold. Globally, climate change is already costing an estimated $US1.6 trillion ($1.5 trillion) per year, rising to over $US4 trillion by 2030. The summer of 2009 brought extreme heat waves to southern Australia, accompanied by Black Saturday bushfires. More than 500 people lost their lives in Victoria due to these climatic events; either due to heat exposure or through severe burns and smoke inhalation from those fires. Then 2010 and 2011 were the two wettest years in Australia’s recorded history, flooding Queensland, NSW and Victoria. Among the developed nations, Australia is at the forefront of vulnerability to the ravages of climate change, as we face increased threats of droughts, floods, storms, fires and heat waves. We are entering a new and wildly disparate climate to the one in which humans evolved and agriculture flourished allowing villages and cities to develop. Our future will be warmer, with greater extremes of temperatures and precipitation; more intense and more frequent droughts, floods, and storms. There is now wide scientific agreement that the world is heading for at least 2°C warming, and possibly 4°C, by 2070, and this will bring greater extremes. With global warming currently less than one degree, hot countries, such as Australia are already beginning to experience temperatures that are not compatible with a healthy and active life. It is difficult to imagine how this can further amplify, to a state where a “normal” hot day is 48°C and extremely hot days approach 58°C. Such horrors are inherently difficult to fathom, however, without mitigation, we
policy & reform are on a trajectory to these unimaginable heat extremes. With such warming, outdoor activity will not be possible. Using CSIRO’s projections for Australia of the likely increase in mean annual temperature by 2070 if no mitigation strategies are adopted, a Perth study identified that outdoor activity would be impossible for unacclimatised people on 33–45 days per year, compared with four to six days per year at present. Their core temperature would rise by 2.5°C in less than 2 hours. Not only will this be too hot for humans to move, work and exercise, but it will also be too hot for animals, cattle and sheep, and for plants. Their leaves will burn. Even at lesser temperature extremes, our stable food crops will wither, and food production in Australia and globally will decline. By this stage, the oceans will be warmer and more acidic, so we cannot expect protein sources from fish. Food shortages will drive conflict and political unrest. Unfortunately, this gloomy forecast is not a horror movie, it is realistic. What we do not know is how soon this will occur. But the trend has already begun, and experts are now convinced that current emissions interruptions to infrastructure caused have now exceeded the barrier of keeping by damage to roads, bridges, electricity warming to less than 2°C. [It passed the and communications. The geographic range of mosquito borne 2°C threshold when the concentration of CO2 reached 330 ppm. It reached 394 ppm diseases will spread southwards. Food borne diseases also increase with rising by the end of 2012]. If nations continue to temperatures. Personal loss will bring procrastinate about reducing greenhouse stress, grief and despair gas emissions, as people struggle projections suggest The geographic to cope with these global warming range of mosquito changes. These will between 4°C and manifest as generating 5.6°C will occur borne diseases greater demand for before the end of will spread mental health services, the century. Some and health sector children alive today southwards. Food responses to other will live to see this. borne diseases also chronic diseases that The pathway to are exacerbated by this sorry state will increase with rising stress, and by stress involve an increasing temperatures. alleviation techniques, array of health Personal loss will such as drug and problems. The need alcohol abuse. Mental for expanded nursing bring stress, grief health services, roles will demand and despair as especially preventive reorientation of services, are lacking in nursing training and people struggle many regions. care provision. In the to cope with these In the short term, all near future, there will changes. new nursing courses be increasing health must prepare nurses threats arising from for a future world, one heat exposure, and quite unlike the one for which we prepared. from exposure to droughts, floods and Australia’s health burden will shift, and storms. health service priorities will change in This will occur against a backdrop of response to economic shifts as countries crop damage, and therefore rising food direct increasing proportions of GDP into prices, potentially food shortages, and www.nursingreview.com.au reparation of damaged infrastructure. There is an urgent need for health promotion, as after mitigation, preparedness offers the greatest protection. Preparedness must occur at all levels: individual, community, industry, institutional and government. The health sector and health sector workforce have a key role to protect and advance Australia’s health. The health impacts of climate change should feature prominently in the education curricula of undergraduate and postgraduate health professionals. n Dr. Liz Hanna convenes the National Climate Change Adaptation Research Network for Human Health, and is president of the Climate and Health Alliance. She transitioned from an Intensive Care Nurse to focus on health related research. Hanna is director of the NHMRC research project investigating Working in the heat under climate change: health risks and adaptation needs, and is chief investigator on several other projects. A fully referenced version of this story is available at www.nursingreview.com.au February 2013 | 17
policy & reform Apple Isle feels the squeeze Amie Larter talks to Neroli Ellis about the state of nursing in Tasmania. shortages within three years if all graduates were employed. Tasmanian nurses and midwives, on average, are the eldest in the country and the impending retirements will create added pressure in the near future. What were the main challenges for nurses in Tasmania throughout 2011- 2012? The significant budget cuts in health in this financial year resulted in the closure of over 100 acute hospital beds, 280 nursing positions slashed, theatres closed, mental health and family child health service and access reduced resulting in major issues with bed block and subsequent ambulance ramping and 25 per cent elective surgery cancellations. The pressures were on all major Tasmanian hospitals which were operating at about 100 per cent occupancy, which is unsustainable for safe patient care over the long term. This resulted in ambulance ramping, re-admissions, and increasing complexity of medical illnesses due to delays in elective surgery and delayed 18 | February 2013 diagnosis of cancer, which are some of the symptoms demonstrating the poor state of our health system in Tasmania. Front-line nurses wore the brunt of most of the effects of the budget cuts and yet continued to do their best to deliver quality services. All sectors of primary heatlh were also reduced with cancellations of mental health and family child health apppointments, and community nursing access reduced. Nurses and midwives received enormous public support. The federal Minister for Health, Tanya Plibesek, announced a $325 million four-year package, which if allocated to the crisis areas would have made a difference. Concurrently, nursing graduate employment was cut by 40 per cent of pre-budget numbers (FTE) despite the Health Workforce Australia projections of There was extensive coverage of the staff shortages, funding cuts and extensive work hours for nurses. What plans need to be put in place to ensure it’s not the same throughout 2013? The outcome of this short-term strategy is evident now with nursing roster shortages, reliance of casual staff and ongoing fixedterm contracts and job insecurity and many of the 280 nurses who lost their jobs last financial year have already moved their families interstate. The ongoing delay in the implementation of the new nursing career structure due to budget cuts is also affecting recruitment with a lack of recognition of the value of nursing and midwifery. The Australian Nursing Federation (ANF) will pursue the classification reviews and implementation of new classifications through ongoing conciliation in the Tasmanian Industrial Commission and pursuit of the finalisation of the working party for a new career structure for community nurses. The human resources processes must be improved and the ANF has recommended implementing KPI’s to improve the recruitment timeframe, which is unacceptable at the current four months for a permanent appointment. The graduate nurse campaign will continue to ensure our graduates can stay in Tasmania for a career pathway. The ANF will be monitoring and intervening in workload issues through the local workload committees and ensuring that permanent employment is offered to assist in retention. How did the state government respond to the issues, and was the response satisfactory? The government made a policy decision to cut the health budgets and reviewed the forward estimates to maintain current
policy & reform cuts without proposed additional cuts this financial year. However, the cuts remain unsustainable and despite the additional federal funding, which only offers less than $8 million for the state elective surgery per annum, access to both acute and primary care will continue to be compromised for Tasmanians. The government’s response has not been satisfactory and the preliminary findings of the Legislative Council inquiry have determined that the community is being adversely affected. Coming into an election year, what will be the main issues on the agenda for nurses and the ANF in the state? 1. Development of a statewide health strategic plan. Many expensive consultant reviews have been undertaken over the last 10 years but yet the health system continues to lack direction and strong leadership. Regional parochialism has to be removed and services offered based on a statewide plan. 2. Appropriate resources to implement this plan must be allocated in the relevant budgets. 3. Implementation and funding for the new nursing career structure, which must include models of care recognising the scope of practice of all levels of nurses including funding for nurse practitioners, nurse-led discharge, walk-in clinics and nurse educators. 4. Development and commitment to a Tasmanian nursing and midwifery workforce plan and graduate nurse program expansion. 5. Funding to reopen critical services in health and ensure Tasmanians have equitable access to the universal health system. What is your vision for nursing in Tasmania? Strong nursing leadership to advocate and lead and promote our profession forward. Support for research and ongoing education to enable nurses and midwives to work at full scope of practice, and value and recognition of the great innovation that continues despite the hardship of the system due to the budget cuts. Clinical information systems to support our practice and enable accurate data to enable practice improvements. The ability to deliver quality care that is supported by the appropriate skill mix and support staff re-employed to enable nurses and midwives to be relieved of the non-nursing duties, which continue to be absorbed by nurses particularly as positions are removed through budget cuts. A dynamic system to enable positive change led by nurses and recognising The government made a policy decision to cut the health budgets and reviewed the forward estimates to maintain current cuts without proposed additional cuts this financial year. those nurses in clinical leadership positions. Support and recognition for nurses and midwives without the constant fight through the obstructions of the bureaucracy. A sustainable nursing workforce plan to be developed and supported to avert the predicted workforce crisis. Aged care funding to ensure nurses and care staffing levels and skill mix to provide quality care to our ageing demographic. n Neroli Ellis is the Tasmanian branch secretary of the Australian Nursing Federation. Postgraduate Nursing It’s never too late to study. We’re in Tasmania but you don’t have to be. USRM9457_RJ CRICOS Provider Code: 00586B Part-time study for a nursing or health professional postgraduate qualification has never been easier with our extensive suite of fully online programs. Courses and units have been designed by practice experts to enhance learning in a range of professional nursing specialisations or health care professional streams. www.nursingreview.com.au With 25 specialisations to select from, learning has never been more accessible. Study four units for a Graduate Certificate or complete eight units for a Graduate Diploma which articulates with the Master of Clinical Nursing or Master of Clinical Midwifery. A Bachelor of Nursing Professional Honours (Specialisation) is also available. Applications are still open to start in 2013, and many specialisations are also available for a mid-year commencement. For more information or to apply, visit www.utas.edu.au/nursing-midwifery February 2013 | 19
specialty focus Personal touch at the practice Practice nurses perform myriad tasks in doctors’ surgeries, one of the most important is to communicate with patients. By Flynn Murphy I t is 1pm on a Wednesday at Glebe Medical Centre in Sydney’s inner west, and nurse Jessica Turner is sneaking a sandwich in between patients. “It’s very busy, especially now that I do pap smears as well,” the full-time practice nurse explains between bites. Last month, Turner completed a course in women’s health at Family Planning NSW, which has allowed her to expand her scope of practice at the centre, qualifying her to perform breast examinations and pap smears. The course was part-funded by the clinic she works at, and part by a government subsidy. “We encourage our nurses to improve their skill sets in private practice. We see it as an investment in our staff,” says Dr Ryan Quan Vo, co-director of the centre, which took out the Sydney Small Business of the Year award last year. Glebe Medical Centre is a 10-room, multi-disciplinary practice with GPs, allied health practitioners, and full-time nursing support. It’s busy right now but not chaotic, a wall poster advertises a new smartphone app that lets patients book an appointment at the touch of their screen. Vo says his clinic caters to a diverse demography, from the socio-economically disadvantaged to young professionals, and is open seven days a week, bulk billing for five. It has sister-clinics in Rozelle and Drummoyne, each of which has a fulltime nurse. Turner joined the centre last 20 | February 2013 Jessica Turner enjoys the work/life balance September, after six months working in the transplant ward of the Royal Prince Alfred Hospital. She previously worked at a drug and alcohol clinic in Ultimo. “It’s a completely different skill set here,” she says. Being a practice nurse means “less drama” than working in the
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