Nursing Review March 2013

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Information about Nursing Review March 2013
Health & Medicine

Published on March 10, 2014

Author: papaRACSi


Australia independe ’s nt voice of nursing Issue 2 March 2013 Weight matters Help for expectant mums Do hospitals need colour-coded scrubs? see page 26 Grads want a chance to work see page 14 Lee Thomas reflects on her career see page 32

More people in health and community services choose HESTA than any other fund Your super fund can make a lifetime of difference 3 Run only to benefit members 3 No commissions 3 Low fees Product ratings are provided by SuperRatings and Rainmaker Information, and are only one factor to be considered when making a decision. See and for more information. 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. Consider a Product Disclosure Statement before making a decision about HESTA products, call 1800 813 327 or visit for copies. 2 | March 2013

contents EDITOR Amie Larter (02) 9936 8610 Journalist Aileen Macalintal production manager Cj Malgo (02) 9936 8772 Graphic Design Ryan Salcedo CHIEF SUBEDITOR Richard Jenkins (02) 9936 8643 SALES Nicola Mohtram 02 9936 8619 SUBSCRIPTION INQUIRIES (02) 9936 8666 10 14 news 04 Roles expanded 24 Babies and immunisation 06 Peace in the west clinical practice 26 Scrubs abuse Will sugar prevent pain? Nurses take on doctors’ tasks WA pay deal accepted Enforcing clothing discipline to stop the spread of infection 08 RCH research unit threat ACN MEMBERS ADDRESS CHANGE 1800 061 660 Academics write to Qld PM 29 Cleaning overhaul Microfibre and steam replace chemicals 10 “Tattoo” vaccines Huge potential for new patches 12 Bahrain medics campaign 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. Audited 15,635 as at Sept 2012 18 Unions unite against human rights violations 13 Sydney-to-Perth ride 26 Nurse completes 4000km mission Nurse practitioner endorsement delays No work for the newly qualified 35 Shiftwork and diet Making the right food choices after a busy shift 17 Workforce crisis looms Cuts today mean staff shortages tomorrow legal corner 36 The right to refuse specialty focus 18 Obesity and obstetrics Do-not-resuscitate orders and thornier issues Emotional and psychological support needed Health professionals give their views Inspirations and election issues at the ANF 34 Have your say policy & reform 14 Graduate unemployment 22 Milk sharing workforce 32 Q&A with Lee Thomas 35 technology 38 Almost the real thing New lab trains students in home care procedures Clinical education and professional development programs endorsed by RCNA. Never stop learning, further your development at March 2013 | 3

news Trial to expand nursing roles Having nurses take over more doctors’ tasks brings efficiency benefits – but also risks. By Amie Larter A limited number of public hospitals around Australia are trailing new initiatives where nurses will be performing procedures normally completed by doctors. In a controversial move, more than 10 nurses within public hospitals throughout Victoria are being trained by and working closely with specialists to screen colonoscopies and cystoscopies. Further trials may even see nurses sedating patients. Dr Brendan Murphy, CEO of Austin Health, which runs Austin Hospital in Melbourne’s north-east, confirmed the organisation was looking at a limited range of advanced practice roles where there was significant unmet demand for diagnostic or screening procedures. “These include screening colonoscopy for the large number of patients who have had positive tests in the bowel cancer screening program, and checking cystoscopy, for patients who have previously had bladder cancers and need review for recurrence,” he said. “Having these dedicated roles makes an enormous difference in the waiting time for patients and releases the medical specialists to do more complex procedures. This means that we can use our resources much more efficiently.” According to Murphy, patients and hospitals won’t be the only beneficiaries, with nurses provided with career development opportunities as a result of the extra duties. He said that for some, expanded roles offered an answer to frustrations over the lack opportunities and extensions. “By extending the roles of doctors, nurses and allied health professionals, we can make their work more rewarding,” he said. “At the same time, we will gradually need to introduce more enrolled nurses, nursing and allied health assistants to work under direct supervision, as we free up 4 | March 2013 RNs and allied health practitioners to take on advanced practice roles. “This will lead to a more sustainable and satisfied health workforce without any threat to the existing workforce, for whom these changes represent only opportunity.” However, Lisa Fitzpatrick, secretary of the Australian Nursing Federation’s Victorian branch, said that the focus of some of these trials may be about “restructuring health professionals to save money under the guise of looming shortages”, and that we should be looking at “why specialists were specialists in the first place”. “We need to respect the extra three to six years training by physicians who specialise in urology, gastroenterology and anaesthesia,” she said, “and we would be concerned about trying to emulate that expertise in a short course or on-the-job training.” Fitzpatrick also said that patients were entitled to the highest level of expertise the health system could offer. “It will be little comfort to patients and families if they are the one-in-20,000 patient and something goes wrong because they were considered a ‘boring’ patient [so their case was delegated to a nurse].” n

news March 2013 | 5

news Pay deal halts WA dispute By AMIE LARTER n urses in Western Australia have voted to accept a 14 per cent pay offer over three years, bringing to a halt a month-long campaign over pay and conditions. The offer from the Coalition government is conditional on them winning the upcoming state election on March 9 and brings to a halt an escalating industrial dispute. Before the deal was made, nurses had started to close one in five hospital beds. Nurses had stopped non-nursing duties for two weeks prior to attending the vote on February 25, work they say did not directly involve patient care and would normally be performed by orderlies or PNCE1 3 _ Ad 0 1 . p d f Pa ge WHY ATTEND PNCE IN 2013 • • • • • • cleaners before recent job cuts. These duties included removing rubbish, stripping beds, restocking of stores and trolleys, cleaning equipment and quality assurance activities. The nurses had originally sought a 20 per cent pay rise over 3 years, far above the state government’s offer of approximately 9 per cent over the same period. Before the vote, ANF state secretary Mark Olson told Nursing Review that nurses were not prepared to accept a 3 per cent a year pay increase that would have left them ranked sixth out of eight states and territories in a 1 2 1 / 0 2 / 1 3 , 4 : 1 4 national wage comparison. “We are living in the most expensive state and we are seeing allied health professionals – teachers, police, doctors – their all the highest paid, and nurses want the same outcome.” Looking longer term, Olsen said the state was going to have enormous trouble filling nursing positions. “I don’t believe the two new hospitals slated for opening in the next two or three years will actually open fully because they will not have enough nurses and midwives in those areas. And that’s simple. That’s not panic, alarm or talk – that’s the reality.” n PM PRACTICE NURSE CLINICAL EDUCATION Earn over half your annual CNE points! Network with associations and educators Diverse choice in seminars and workshops Gain access to leading healthcare companies Learn and share experiences with fellow Practice Nurses Experience Australia’s largest series of Practice Nurse Conferences! ORGANISER SYDNEY PERTH BRISBANE MELBOURNE 18 & 19 MAY 2013 20 & 21 JULY 2013 21 & 22 SEPT 2013 16 & 17 NOV 2013 MEDIA PARTNER MEDICAL ENGAGE. INNOVATE. EXPERIENCE. WWW.PNCE.COM.AU 6 | March 2013

news Support for casuals • Nurses in casual or part-time work may be less financially comfortable and more stressed than those in more permanent employment, says the latest ME Bank Household Financial Comfort report. ACTU president Ged Kearney believes this is no surprise, as workers don’t know what 4th Annual National Disability Summit Victoria’s grad success 21 - 22 March 2013 | Novotel on Collins • Twenty-five graduate nurses have recently completed LASA Victoria’s 12-month Aged Care Graduate Nurse program. This is the first group to complete the course, which is funded by the federal government. The program involves seven weeks of training spread out over a year and includes study days, leadership and accreditation courses, as well as the development of industry specific clinical skills. High care, low care, palliative and dementia specific care are a few of the different areas covered by the course. Graduates were employed in a supported environment at one of LASA Victoria’s aged care providers’ facilities, which contributed 12 credit points to a Master of Nursing (Aged Care) at Monash. 12 - 13 March 2013 | Novotel on Collins 5th Annual National Telemedicine Summit 20 - 21 March 2013 | Pullman Sydney, Hyde Park 22nd Annual Medico Legal Congress 21 - 22 March 2013 | Sydney Harbour Marriott calendar • The federal government says that Victoria’s health system has missed out on more than $12 million of funding because it did not complete the paperwork that guaranteed the money. The state Health Minister David Davis disputes the federal government’s data collection methods, maintaining that his state’s system is casebased and this was simply an attempt to “punish Victorian patients” after they exposed cuts to health funding. Federal Health Minister Tanya Plibersek wrote to Davis stating that she was concerned with Victoria’s lack of visibility and that if the correct data was not received by the end of February then Victoria would miss out on the funding. Plibersek maintains she wants to make sure any extra funding for Victoria’s health budget gets to patients. their income will be from one week to the next. She is calling for all political parties to tackle the rise in insecure work, pushing for an entitlement portability scheme that would extend these entitlements to casual and short-term workers. Kearney said the report shows that the gap in comfort between higher and lower income households is extending – another sign inequality is on the rise. inbrief Federal funding withheld 3rd Annual Developing the Role of the Nurse Practitioner Conference 3rd Annual Hospital Patient Costing Conference 21 - 22 March 2013 | Stamford Plaza Brisbane patientcosting 2nd Annual Electronic Medication Management Conference 25 - 26 March 2013 | Hilton on the Park, Melbourne 3rd Biennial National Falls Prevention Summit 16 - 17 May 2013 | Stamford Plaza Brisbane 13th Annual Hospital in the Home Conference 23 - 24 May 2013 | Novotel Melbourne on Collins 2nd Annual Preparing for Personally Controlled eHealth Records 27 - 28 May 2013 | Sydney Harbour Marriott 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. 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news Research cuts anger senior staff A The closure of a child health research unit is the last straw, says a large group of leading health professionals in Queensland. By Aileen Macalintal However, Newman said the claim that nursing research had n open letter to the Queensland Premier from 39 been cut at RCH was untrue. professors, doctors and other health professionals “In fact, we are seeking to enhance nursing research through the questioning the closure of an internationally recognised newly formed Children’s Health Queensland Board. The board will research unit in Brisbane has appeared in state newspapers. focus on inter-professional partnerships and bring together a range The letter was published as a full-page ad and paid for by the of clinical disciplines into a contemporary model that will improve Queensland Nurses Union. It was signed by Linda Shields, a clinical care,” he said. professor of nursing at James Cook University. Newman said the Queensland Nurses Union never raised this “We, the undersigned senior nurses and academics, are issue during the Health Minister’s regular meeting with them. appalled by the Queensland Government’s decision, via the “Rather than waste their members’ money on taking out fullhospital’s board, to abolish the Nursing Research Unit at the Royal page ads that spread misinformation, we would advise they spend Children’s Hospital (RCH),” the letter stated. their money taking out ads fighting the federal Labor government’s Shields believes that the “closure of this world-renowned cut of $103 million to the Queensland Health budget,” he said. n children’s health research unit is a decision that will undermine the effectiveness and reputation of children’s health ADVERTISEMENT services in Queensland”. “I was incensed that a highly productive research unit, led by a nurse with a terrific international reputation, supported by millions of dollars of grants, and Newman and Springborg cut whose work had demonstrably improved the health of vital research into kids’ health children and families, was being cut,” said Shields. The letter, addressed to Campbell Newman, was Open letter to Campbell Newman and Health Service; also sent to Health Minister Lawrence Springborg, nd Hospital Chief Executive, Children’s Health Queensla rg, Minister for Health; Dr Peter Steer, Service Also sent to: The Hon Lawrence Springbo ’s Health Queensland Hospital and Health Ms Susan Johnston, Chair, Children as well as Dr Peter Steer and Susan Johnston, chief the health of executive and chair (respectively) of Children’s Health Dear Premier important research unit has improved This is one example of how this into children’s engaged in vital national and international research better care where the provider is actively Queenslanders, and contributed to Evidence shows that patients receive are many others, reducing infant mortality rates. There Queensland Hospital and Health Services. health issues, including research into research. the needs of nursing, improving breastfeeding rates, care, including intensive care and oncology e and translation of knowledge into patient The closure , and fever management in children. Nursing research, the generation of knowledg of the public parents during a child’s hospital admission It raised a call to restore funding for the Nursing ent in health care delivery and the health will undermine the is fundamental to ongoing improvem by the health research unit is a decision that of this world-renowned children’s ed senior nurses and academics, are appalled health services in Queensland. and patients. That is why we, the undersign to abolish the Nursing Research effectiveness and reputation of children’s nt’s decision, via the hospital’s board, Research Unit and stop all health service cuts until the Queensland Governme such as this, that to suggest, through word or actions (RCH). It is dangerously ill informed for anyone Unit at the Royal Children’s Hospital Combined with so children’s health services in this State. currently meets its such a unit is not an essential part of announced in children’s health services and it impact of these issues have been fully assessed. cuts to health services and staffing being Queensland Health is a world leader ent, through research, of many other unnecessary and dangerous message that Queensland obligations to the ongoing advancem national and international health research unit sends a internationally at this time, this decision on the child ent of Research Unit at RCH is recognised and the ongoing improvement and advancem children’s health services. The Nursing The unit, led by Dr Jeanine Young, plays a key role prepared to play its part in research which has provided results that have is not of evidence, to retain good for its high quality research and production of such actions on the morale and ability here in Queensland health services. The negative effect of children and their families, both made a real difference to thousands line of front in programs and campaigns that aim to reduce infant clinical staff is profound. Young and her team have been at the and around the world. In fact, Dr Jeanine service cuts funding for this unit and cease all health inception of the unit 12 years ago. We call on you, as Premier, to restore paediatric nursing research since the and greater public the impact of each cut is carried out sudden infant mortality. Their projects include the identification of until, at least, a full assessment of the “safe sleeping campaign” against Boards, that is example, the unit is a key player in For nt, and not the 17 Hospital and Health Reducing infant mortality is a debate is allowed for. It is governme policy and funding parameters for sudden infant death syndrome (SIDS). y for providing the deaths, including identifying ultimately accountable to the communit infant care practices in Queensland and the “safe Research Unit played a key role in specific COAG target. The RCH Nursing risk of health service delivery. d parents that placed infants at an increased infant care practices used by Queenslan of evidenceto lead Australia in the development sleeping campaign” to fight sudden infant death. sudden death. The unit’s team has continued s to staff and Yours faithfully safe infant sleeping, innovative approache based policy and practices relating to (recipient of Safe Infant Sleeping eLearning program parent education including the national “Nursing research will be under a department called engagement with culturally appropriate approaches of an international award in 2010), and asked by Professor Linda Shields, ive work in this area, Dr Young was collaborat , FACN Indigenous communities. Due to her in 2012. MD, PhD, MMedSci, BAppSci (Nursing) ‘Education and Workforce’,” said Shields. Safe Sleep My Baby public health campaign SIDS and Kids to launch the national rate of infants Alligator Creek, Queensland collaborative research findings, the With the implementation of Dr Young’s d has continued to fall. “This means the downgrading of nursing research suddenly and unexpectedly in Queenslan dying and will result in lack of evidence generation or the ability for nurses to translate research findings into practice, because the ‘hands-on’ approach that has been characteristic of the particular research unit will, by definition, disappear.” Shields said the nursing research unit will find it difficult to attract grant funding if it is subsumed under the workforce and education banner. “The research, which might benefit children and families, will not occur and, subsequently, the THE QNU AGREES - IT’S A DISGRACE long-term outcome for their health care will be The QNU fully supports these nursing leaders and educators. These cuts to children’s health research are Included in this income bonanza is a significant increase in funding from the Federal Government - federal unnecessary and a step backwards - like so many of the cuts to hospital and community health services, grants to Queensland will increase from $18.4 billion in 2012, to $21.8 billion in 2013-14 and then to compromised. Also, nursing as a research profession being imposed by the current State Government. We also call on the premier to reverse them. $23.8 billion in 2014–15. That’s right, nearly $3.4 billion extra next year and $5.5 billion extra the year after that. Yet the Newman Government claims we can’t afford to fund things like research into reducing The fact is, the Newman Government’s own Mid Year Fiscal and Economic Review 2012–13 confirms infant mortality. What a disgrace. that the State Government’s revenue will grow by nearly $10 billion over the next two years, from $41.5 will be devalued and so high-quality researchers will billion this year to $47 billion next year and then to $51 billion in 2014–15. That’s right, about $10 billion For more information on this issue and the QNU’s Hands Off Our Public Health Services campaign go over two years. to: not be attracted to work in the new children’s hospital.” She said the current research would continue no matter what the outcome since it is funded by federal grants, “and Dr Young, like all good researchers, is ethically bound to continue it.” Authorised D. Elder, acting secretary, QNU, Brisbane THIS IS NOT GOOD On behalf of the undersigned: of Nursing & CEO, St. Andrew’s War Isobel (Pixie) Annat – former Director Memorial Hospital, Brisbane Professor, Amman, 11942 Jordan Dr Diana H. Arabiat - RN, PhD, Assistant Services, Royal Brisbane Hospital Cecilia Brazil - former Head of Nursing and Nursing History Consultant 1983 to 1986, Researcher, Historian Turkey Professor Hicran Çavuşoğlu - Ankara, Emergency Nursing Professor Rose Chapman - Professor PhD, Hull, UK Dr Robert J T Clucas - LLB, PCHE, BA, B App Sc (Nursing), Post Grad Diane Collins – RN, Dip App Sc (NEd), ), MPH, FACN, Brisbane Cert (OnlineEd), Grad Cert (Gerontology Cranley - Registered Nurse, Perth, WA Jane Outreach Education, WA Hilary Cross - Coordinator of Neonatal UK Professor Nicky Cullum – F Med Sci, - PhD, MBA, RN, Vancouver, Canada Assoc. Professor V. Susan Dahinten RSCN, RHV, PGCHE, Hull, UK Barbara Elliott - MSc, B Nursing, RGN, of Italy, on behalf of the Italian Society Professor Filippo Festini - Florence, Sciences, Italy Pediatric Nursing Margaret Fletcher - Bristol, UK Professor M Serv Admin, BSc, FACN, Perth, WA Dr Heather Gluyas - RN, D Nursing, Jennifer Hall - Senior Librarian, Brisbane Dr Nils Hansson - PhD, Lund, Sweden Professor Yvonne Hauck - Perth, WA WA Professor Desley Hegney - PhD, Perth, FACN, Perth, WA Professor Mark Jones – FCNA (NZ), 8 | March 2013 Soc Sci (Nursing), BA, RN. Perth, WA Dr Garth Kendall - PhD. MPH, Dip Lisa Kreusi - MBIT, New Farm, Qld Dr Bill Kreusi - New Farm, Qld on, B Nursing, Dip App Sci Kate Kunzelmann - RN, M Health Administrati (Nursing Management), Brisbane (Paeds), RN, Tasmania Damhnat McCann - MPH, Grad Dip - AM, RN, PhD, FACN, Gold Coast Emeritus Professor Anne McMurray , UK Dr Sarah Neill - PhD, Northampton RN, Perth, WA Helen Nelson - PG Dip Nursing (MH), Scotland UK Dr Alison J O’Donnell - PhD, Dundee, WA Tony Patton - Nurse Manager, Murdoch, CCHV (UK), Brisbane Paula Penfold - BSc (UK), RN, RM, RHV, BSc (HONS), RNT, PGCE, PhD, Dr Duncan Randall - RGN, RSCN, Birmingham, UK Dr Wendy Smyth - RN, PhD, Townsville Executive Director, The Truth About Sandy Summers - RN, MSN, MPH, Nursing, USA Union Dr Liz Todhunter - Queensland Nurses’ CertEd (HE), RGN, RMN RSCN, Dr Alison Twycross - PhD, MSc, DMS, London, UK M Cog Sci, Grad Dip Hlth Econ, Joy Vickerstaff - AM, Dip N Ed, BA, and ACT, The Gap, Qld Retired Chief Nurse - Queensland candidate, Toowoomba, Qld Kym Volp – RN, RM, PhD Huaqiong Zhou - RN, MCN, WA

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news Tattoos inspire new DIY vaccination method A pain-free delivery method for DNA material to be placed in the skin holds great potential for developing countries. R Bathe the easy way… …with the amazing Easy Way Bath DESIGNED TO MAKE LIFE EASIER: • Hospitals • Nursing Homes • Rehabilitation Centres • Private Homes • Aged Care • Disabled Facilities …raise the bather to your level • Allows the continued enjoyment and pleasure of a warm bath • Reduces back stain on the carer • Simple installation into new or existing facilities • User friendly – simple hand or foot control • Exceptionally affordable • Reliable • Minimal maintenance • Available with spa unit • Designed and manufactured in Australia Easy Way Bath Pty Ltd PO Box 419 Latrobe TAS 7307 • 0408 311 333 • 10 | March 2013 esearchers have developed a patch that uses barely visible needles to inject a new DNA vaccine under the skin, much like tattoo needles – only painlessly. DNA vaccines work by inserting DNA holding the code of a virus or bacteria protein directly into the body’s cells. The body then detects this foreign protein and creates an immune response. However, to date, DNA vaccines have failed to generate immune responses in humans in the same way as conventional vaccines, and they have not yet been shown to be safe, reproducible and pain-free. But new research from Massachusetts Institute of Technology (MIT), published in Nature Materials, has led to a pain-free DNA vaccine skin patch that has been proven to work on macaque monkeys. This patch proved over 100 times more effective than a normal needle. “The hope is that this technology would provide a lowercost means to deliver vaccines, which might even be selfadministered in the future,” said one of the researchers, Darrell Irvine, from the Department of Materials Science and Engineering at MIT. “As it is based on DNA, it may also provide a universal platform for developing vaccines against many different diseases, by simply changing what the DNA encodes,” Irvine said. The microneedles, which don’t penetrate to the nerve endings of the dermis and which are therefore painless, quickly dissolve, leaving behind a film that releases the vaccine for weeks. “Like tattoo ink that is deposited permanently in the skin, these skin patches deposit a very thin layer of polymer film containing DNA into the skin. Unlike a tattoo, these ‘DNA tattoos’ dissolve over a few weeks to carry out the vaccination,” Irvine said. This delivery method has huge potential for the developing world, especially as the vaccine patches don’t need to be refrigerated, and it could one day be used to vaccinate people against HIV and perhaps even train the immune system to fight cancers. n

news save way with salary packaging Take home as much as $2,960 more in pay each year. As a health services employee, you could receive up to $2,960 more in disposable income each year by salary packaging with Maxxia. With the Maxxia Visa Card, you can pay for everyday expenses such as clothes, shoes, groceries and bills using pre-tax dollars. So whatever your lifestyle, Maxxia could help you save. Maxxia offers: • Peace of mind - Talk to a real person when you call • Convenience - Manage your account online 24 hours a day • Inclusiveness - Even part-time and casual workers could claim Find out how you could get more out of your salary with the Maxxia Visa Card. CALL 1300 123 123 Talk to your HR adviser and find out whether you’re eligible to salary package with Maxxia. Things you need to know: Salary packaging is subject to eligibility criteria and terms and conditions (available from or by calling us on 1300 123 123), and your employer’s Salary Packaging Policy. PAYG tax rates effective 1 July 2012 have been used, fees and charges apply. Your savings may vary depending on your particular financial, taxation and welfare benefit circumstances. You should seek independent professional advice before salary packaging. Maxxia does not provide financial, taxation or financial product advice on the relative merits of salary packaging or on any other basis. Maxxia may receive commissions or rebates in connection with some services it provides or arranges to be provided by third parties. Maxxia Pty Ltd ABN: 39 082 449 036 Auth Rep (No. 278693) of McMillan Shakespeare Ltd (AFSL No. 299054). March 2013 | 11

news Call to release Bahraini medics A ustralian groups have launched a campaign to condemn ongoing human rights violations against nurses and other health workers in Bahrain. The Australian Council of Trade Unions (ACTU) and Union Aid Abroad-APHEDA have supported the Australian Nursing Federation (ANF) in this campaign, which marks the second anniversary of the crackdown on Bahrain’s anti-government demonstrations, sometimes known as “the forgotten Arab Spring”. Support is also coming from the federal Senate and the House of Representatives, as the Greens and the Australian Labor Party finalise motions to protect human rights in Bahrain. The Bahrain Centre for Human Rights has reported at least 87 deaths and more than 1,800 arrests of prodemocracy protesters since February 2011. Military suppression of mass pro-democracy protests has extended to the health services, with more than 90 medical staff meeting violence. Some, including nurses, have been arrested and tortured for attending to injured protesters. ANF Federal Secretary Lee Thomas said: “We are appalled that nurses and other healthcare professionals in Bahrain continue to be locked up simply for doing their job – caring for the sick and injured. “Two years after the uprisings, we’re told there are still seven medics being held in Bahraini prisons, including Ibrahim al-Demistani, general secretary of the Bahrain Nursing Society.” Thomas said the ANF condemned human rights violations and hoped to highlight the pressing need for action. To read more about the imprisoned health workers, see: bahrain-solidarity-campaign, where you also send a message of support. n Fr ee The dressing protector that keeps wounds dry while showering Keep-Dri Dressings An effective solution to wound management and infection control in the hospital and home. Type 2 diabeTes Prioritising CVD risk and managing medicines Rectangle protectors available in four sizes – Perfect for small to large wounds, catheters, hip replacements and drainage sites. View the webinar recording to learn more about: Management of type 2 diabetes according to CVD risk Bag protectors available in two sizes – Perfect for leg and arm casts, knee replacements and varicose veins. Management of blood glucose, blood pressure and lipid levels Earn 1 x Continuing nurse education point with APEC on behalf of the Royal College of Nursing, Australia • • • • Waterproof and hypoallergenic Ready made Simple to use Benefits nurses, patients and hospitals • Time and money saving Register at Independent, not-for-profit and evidence based. Funded by the Australian Government Department of Health and Ageing. ABN 92 347 834 602 002 12 | March 2013 Australian owned and manufactured T +61 8 9271 4844 F +61 8 9271 4846 E

news Cycle of change B On the fourth day I did my first 160 km, and I knew from then on that I could do it. runo Cordier, a Perth-based palliative care nurse, has completed a 4097km bike ride across Australia, all in the name of charity. Cordier set off on his adventure from Sydney on January 11, reaching Perth on February 14. He rode unassisted and without a support vehicle for the entire journey. His efforts raised over $40,000 for Hamlin Fistula Ethiopia – a charity close to his heart after he and his partner Gracie visited one of Dr Catherine Hamlin’s hospitals on an overseas trip. When speaking of the physical challenges of the trip, Cordier said that it took a couple of days to get into his rhythm. “The first two days in the Blue Mountains were really hard, with high temperatures, really steep inclines,” he said, “but on the fourth I did my first 160 kilometres, and I knew from then on I could do it.” The stretch of road from Norseman to Coolgardie was the next-biggest physical hurdle, due to hilly country with narrow roads and many road trains. “Halfway, at the only roadhouse, I got distracted talking to an English couple. I forgot nearly half of my water and in the last 50 kilometres I nearly fainted three times!” Cordier recalled. “I had to sit quietly in the shade, cross-legged, bring my heart rate down and remain mindful and focused.” Although he found the stark and unchanging Nullabor a challenge, Cordier used this part of the ride to meditate. He ended up embracing the solitude and he enjoyed sleeping every night in the bush, describing “the night sky, the outback and its amazing, unforgiving beauty” as one of the highlights of his experience. That and, of course, the final stretch home, riding 240km downhill in one day and finally seeing Perth city. Delighted to be home in one piece, Cordier has hung up his riding shoes for a while: he’s not planning to do any serious cycling for at least six months. n March 2013 | 13

policy & reform Trained but nowhere to go Nurses around the country are struggling to find graduate placements so industry leaders are calling on state and federal governments to solve the urgent problem. Flynn Murphy reports I t’s an ugly time to be a graduate nurse in Australia. A fraction of this year’s cohort have secured graduate placements vital for their transition into the workforce, and many are considering other professions or looking seriously at moving overseas. Unemployed nurses are collecting Centrelink payments, and those fortunate enough to gain an interview sometimes travel hundreds of kilometres just to be rejected. Quinn McGuinness, 20, is due to graduate from Curtin University in July. He hasn’t found a graduate placement yet, and doesn’t like his prospects. “I have several months of unpaid hospital experience, several years of paid experience working as a care assistant in aged care and other practical placements such as working for the Royal Flying Doctor Service under my belt. I have even received cash grants off the government to become a nurse,” he said. McGuinness – who believed that with the nursing profession in high demand, the degree would provide job security – said he was now facing the prospect of being registered with the Nursing and Midwifery Board, but unemployed. 14 | March 2013 While Australian Institute of Health and Welfare figures for 2012 are not yet available, the Australian Nursing Federation (ANF) estimates that only half of the nurses that graduated in South Australia last year have been employed, only 30 per cent of nurses in Tasmania, and as few as 10 per cent in Queensland. The union said 800 graduates were without employment in Victoria. Where the jobs are Queensland Nurses Union secretary Beth Mohle said her state was worst hit by the shortage, due to the state’s widespread, ongoing health cuts. In one example, she said the Royal Brisbane Women’s Hospital graduate program would this year take a fraction of the approximate 170 new graduates admitted last year. RBWH responded in a statement that it would employ 12-16 new graduate nurses in 2013, though it recognised the importance of providing the positions. In NSW, things are looking better, with the health ministry announcing in early February that in addition to 600 graduate nurses and midwives who had found positions in the state, a further 1400 would “take up duties in the weeks and months ahead”. In Western Australia, the Health Department last year offered 827 places in its graduate program. Around 1400 applied. The issue promises to take on a political dimension in the lead up to the March 9 state election, with a graduaterun campaign called “Give Grad Nurses a Chance” attracting 500 followers on Facebook and a great deal of media attention. The campaign, backed by the federal branch of the ANF, the state branch of United Voice, and WA opposition health spokesman Roger Cook, included a rally by graduates at the WA Parliament in November. One of those at the rally was Edith Cowan University graduate Jess Tully, who started the campaign’s Facebook page and has become something of a spokeswoman for disenfranchised graduates. “I just want to be a nurse. That’s what I want to be. It’s driving me insane,” said Tully, 21, who since graduating in December has been working 12 hours a week at a pharmacy, and still qualifies for Centrelink payments. She said she had searched all over Australia for a graduate position. “I just sit here on the computer all day filling out forms and cover letters … There have been

policy & reform I just want to be a nurse. That’s what I want to be. It’s driving me insane. a lot of rejection emails. A few have told me straight out that it’s because I’ve got no experience, and others have told me that after I called up. “I just don’t think [the WA government] planned for so many graduates. They told us right at the end of uni we didn’t need a graduate placement [to be employed], and that we could work anywhere as an RN. So I started thinking it would be OK, that I could get a job elsewhere. But that’s not the case at all.” Ariane Baayens transferred to nursing two years into a degree in criminology and psychology, believing it would provide a more stable career. “It’s really not good enough,” she said, adding that she wouldn’t advise anyone to do a nursing degree. “I feel like it’s been a waste of time and money.” When asked where she sees herself later in the year, she replied: “on Centrelink.” ANF federal secretary Lee Thomas said the graduate placement situation across Australia was a crisis, given Health Workforce Australia’s prediction that the country would be short 109,000 nurses by 2025. “We have nurses educated, ready to work, and they can’t get work. It’s madness.” But just who is to blame for the shortage? Passing the buck According to the ANF, the disconnect between the federal and state governments is partly to blame. This is theme of their Australia-wide campaign on the subject: ‘Stop Passing the Buck! Nursing Grads Need Jobs!’ While the federal government has jurisdiction over broader workforce planning and tertiary education, the state and territory governments actually employ the majority of nurses. “We see this as a unique opportunity for [state and federal governments] to actually work in co-operation to solve this problem,” said Thomas. “But you’ve got the state governments saying they don’t have enough money and the federal government saying ‘well we don’t employ nurses’.” “Workforce planning has been done in a vacuum … It hasn’t connected education to health services,” said Professor Phillip Della, head of Curtin University’s school of nursing and midwifery. “The number of nurses we take into our programs has been very directed by health workforce planning,” said Della. “In Western Australia that was 1000 graduate nurses a year to meet workforce demand. The mismatch is between the workforce planners and their utilisation when graduates come out.” Governments have downplayed the lack of available graduate positions, maintaining that nurses can get jobs without undergoing a graduate placement, but graduates who spoke with Nursing Review said that the nurse managers who had rejected them consistently cited their limited experience. Della added that while placements were an essential part of a nurse’s education, they were about more than just helping graduates transfer their knowledge into a practical clinical environment – the support and mentoring they provided were essential to ensure nurses remain in the workforce. “There are jobs they can get straight out, but if you want to be serious about retention of nurses, you need to support them in their first year. It’s a minimal cost, but support them and they are more likely to stay within the health service.” Thomas said every graduate that wanted a placement should be provided with one. The graduate crisis isn’t just affecting younger nurses. Like many in this year’s March 2013 | 15

policy & reform cohort, Reshid, 46, came to nursing from another profession, These graduate nurses are putting herself through a nursing our senior nurses of the future, degree at the University of South Australia while working full-time and it’s nonsense that we can’t at a bank. She also made the get them jobs. Unless we do decision to study nursing to ensure something now we are going to her job security – and her fears about the banking sector were be in a terrible situation in a few realised when she was made years. redundant last year. Despite good grades, Reshid has been rejected for entry-level jobs at hospitals in Tasmania, Queensland and South Australia, being told she lacked the relevant experience. She once drove 300km for an interview that was ultimately unsuccessful. “I’m willing to relocate anywhere and ready to take any nursing position in a rural area, or any regional hospital, as long as I get a way to solve the problem. chance to practice … what’s frustrating is I know I’ll have possibly She suggested the federal another 20 working years left in me, yet I feel time is running out for government could refund the my new career,” she said. HECS debt of nurses taking placements in areas of high need, “I am desperately keen to kick-start my career in nursing.” such as rural and remote health. “There are lots of missed opportunities. We see graduate years run pretty much exclusively in public hospitals and private acute Solutions [care], and we’d like to see some support for graduates to work Although she has never been to Centrelink, Reshid decided to in some of those non-traditional graduate year areas, for example register for job-seeking assistance, but was told she needed to be primary care, schools, doctors’ surgeries, community centres.” unemployed and on benefits for three months before they would Thomas said graduate programs which rotated through various start assisting her search. areas were an option worth discussing. She has decided to undertake a short-term pathology collection “It would take some organisation but we need to think outside course to improve her chances of finding work, and is considering the square – there are many positions that graduates could rotate leaving the country if that fails. through and get a well-balanced graduate year,” Thomas said. Thomas said innovative and creative thinking were the only “These graduate nurses are our senior nurses of the future, and it’s nonsense that we can’t get them jobs. Unless we do something now we are going to be in a terrible situation in a few years.” Health Workforce Australia (HWA), a federal workforce planning body, launched the Nursing and Midwifery Graduate Jobs information portal in January last year to help link up graduates with health services. A spokesperson for HWA said the portal, which is free to use for both employers and graduates, could highlight non-traditional placements in settings such as primary care, aged care and Aboriginal health. In the first year of operation, the portal has registered 2426 graduates, but HWA does not keep figures on how many graduates have been successfully placed. Thomas said the idea of the portal was “absolutely right”, but that the reality was there just weren’t enough jobs to go around. Meanwhile, Professor Della said it was too early to tell if the current job insecurity would have an impact on enrolments. “We Share your skills with the global community haven’t seen a drop in applicants. Curtin has the highest entrance score [for a nursing degree in Australia], and we take two intakes a year at 250 students an intake. “The impact will be in the later years, when graduates aren’t Each year, hundreds of Australians take up the challenge to live and getting jobs,” he said. work in developing countries, as part of the Australian Government’s “Nursing’s a fantastic career,” said Thomas, who is herself a Australian Volunteers for International Development program. These registered nurse and midwife. “But we have a group of graduates Australian Volunteers use their skills to contribute to community this year who may well be looking for jobs elsewhere. I think that’s development and poverty alleviation through Asia, Africa, Latin America, just not acceptable. the Caribbean and the Pacific. Volunteers work in a range of sectors “They’ve wanted to be nurses, they’ve educated themselves to including Education, Environment, IT, Finance, Sport, Marketing/ Communications, Health, Law, Gender as well as many others. become nurses and have a HECS debt of $18,000 to $20,000 as a result of their education, and yet they can’t get jobs. I wouldn’t The Program provides return flights, insurances, living and like to think that that would turn people off, but … unless we do accommodation allowances, training and in-country support. something people are going to think twice about doing nursing, Find out how you can share your skills at and that’s going to leave an even greater hole in years to come.” n >Volunteer Overseas. The Nursing and Midwifery Graduate Jobs information portal is available at 16 | March 2013

policy & reform Trained up & nowhere to go We need to find graduate positions for new nurses to prevent a future staffing crisis. By Penny Paliadelis Queensland Health had received 10,400 applications for graduate nursing positions, but employed only 2,467 of them. M ore than a decade ago, the National Review of Nursing Education report, Our Duty of Care, found that not all nursing graduates were able to gain entry to graduate nursing programs. The 2002 report identified that “even if a facility has a graduate program, there is no guarantee that all new graduates employed there will be offered a place on the program”. So if the difficulty of getting into a graduate program is not new, what is making the current situation for newly graduated nurses even more challenging? Graduates feel understandably disillusioned by the difficulty in securing a new graduate position, as most entered nursing courses when universities were being funded to increase enrolments to meet projected nursing workforce shortages. It was predicted that a mass exodus of baby boomers in the early 2000s would leave a huge gap in the nursing workforce. A recent report by Health Workforce Australia, Health Workforce 2025, continues to provide compelling evidence of a looming shortage of nurses, with a suggested shortfall of more than 100,000 by 2025. However, there appears to be a mismatch between the predicted shortages and the number of positions vacant. The Courier-Mail reported last November that since 2010, Queensland Health had received 10,400 applications for graduate nursing positions, but employed only 2467 of them. Tasmania offered only 140 graduate positions across both the public and private health sectors in 2012. The lack of graduate programs has more to do with funding than anything else, as state and territory governments grapple with increasing budgetary pressures, forcing them to cut health spending. The situation is exacerbated by the high cost of delivering structured graduate nurse programs, because of the need for supernumerary days, education days, supervision and mentoring to ease the transition of new graduates into the workforce. So reducing or cutting these programs is an easy way to reduce costs. In rural areas the need to recruit and retain registered nurses is even more acute, and the preliminary results of a study by Jackie Lea at the University of New England suggests that rural facilities have difficulty actually recruiting into graduate programs as there is no guarantee of ongoing employment after completion, and there are few alternative employment options in small rural towns. The shortsightedness of such strategies cannot be overstated. The evidence is overwhelming that Australia will experience a critical shortage of nurses in the future as the projected mass exodus of older nurses has been delayed; staff have stayed longer in employment as a result of the global financial uncertainty and the poor performance of superannuation funds. The cutting of new graduate programs will force new members of our profession to seek employment elsewhere or take their skills overseas. This cycle of oversupply of new graduates, followed by shortages, is similar to previous cycles in the 1990s and 2000s. The coming decade will also see a dramatic increase in demand for healthcare services, so the existing nursing workforce will experience even greater workload demands if this situation is not addressed. When will governments learn that it is false economy to see the nursing workforce as a financial liability? When will they stop using nurses as pawns to balance health budgets for the next election? The federal government needs to develop a national scheme to fund new graduate programs to support nurses’ educational development and career pathways, much as Health Workforce NZ is doing, rather than promote the use of unregulated health workers as the solution. Funders of healthcare services clearly need to adjust their focus to see the recruitment and retention of professional nurses as an investment in the health of our nation, and commit funding to nurture our new graduates to lead us into a healthier future. n Associate Professor Penny Paliadelis is acting head of the school of health at the University of New England, NSW. March 2013 | 17

specialty focus Programs to tackle pregnancy & weight Australians are putting on the kilos and this causes problems for pregnant women. But health workers and patients are working on it. Amie Larter reports They are more likely to end up with inductions or caesareans due to increased risk factors. If they end up having a caesarean the risks are definitely increased. 18 | March 2013

specialty focus T he prevalence of obesity around the nation has more than doubled in the past 20 years. According to the results from the 2011-2012 health survey released by the Australian Bureau of Statistics in 2011-12, some 63.4 per cent of people aged 18 years and over were overweight or obese. This percentage was made up of 35 per cent being overweight and 28.3 per cent obese. Percentage wise, Australian women are less likely to be overweight or obese then Australian men, however, they have seen the biggest rise over the past decade. Since 1995, the average Australian woman has put on 4.1 kilograms, growing from 67kg to now weighing 71.1kg. As the childbearing gender, these statistics have caused an increase concern regarding the prevalence of adiposity in our obstetric population. Adverse pregnancy outcomes due to being overweight or obese are well recognised. Published in The Medical Journal of Australia, the paper Overweight and obesity in Australia mothers: epidemic or endemic? confirms that adverse effects can include hypertension in pregnancy, gestational diabetes, caesarean delivery, perinatal mortality, and baby and neonatal morbidities including jaundice and respiratory distress. Hannah Dahlen, Professor of Midwifery at the University of Western Sydney’s school of nursing and midwifery, says that due to the health risks that develop for both mother and baby, pregnant women with a higher body mass index have a higher rate of intervention at childbirth. “They are more likely to end up with inductions or caesarean sections due to increased risk factors,” Dahlen said. “We know if they end up having a caesarean that the risks are definitely increased. They are more likely to have anaesthetic issues, wound breakdown and infections as well.” Rural focus Recent results from a six-year study in Victoria’s Goulburn Valley show that there is an exceptionally high incidence of obesity in this rural area – with more than twothirds of the 6000 women studied either overweight or obese throughout their pregnancy. Co-author of the study and clinical services director with Victoria’s Western Health, Associate Professor Glyn Teale, says obesity has commonly been more associated with non-metropolitan areas. Teale says the underlying reasons for this are “very complex social issues”. The paper, A profile of body mass in a large rural Victorian obstetric cohort, highlights the extraordinary levels of obesity in a pregnant rural population. “The complications of overweight and obesity [in pregnancy] are such that you will often need to have specialist care,” Teale said. “Lots of rural areas in particular do not have specialist care. Smaller hospitals that may deliver 50-500 women is not going to attract a specialist to such a position ... as a specialist is probably not going to be able to function in a hospital like that because of the deskilling nature of the low birth rate.” This leads to the consideration of further training the current workforce to better manage the complications. GPs, obstetricians and midwives could be imparted with specialist knowledge, however, as confirmed by Teale, this still means women are lacking specialist care. He suggests that instead we need to ensure the rural workforce in particular is aware of the increased risks associated with obesity. “One of the things various guidelines are advocating is that there is increased surveillance for [these] women.” Increased surveillance could entail a change in expectations for health professionals. Instead of seeing an overweight woman and expecting that she will present with a low risk profile and only seeing her every fortnight throughout later stages of the pregnancy, Teale suggests that she be seen weekly or sometimes even more frequently than that. “Be aware that a chance of her developing a problem is much greater. Have your antenna out for detecting a problem and pick up any complications as early as possible so they can be properly managed.” What women want Jane Raymond, (previously) the project midwife, Sutherland and St George Weight Intervention Group (SSWInG), South Eastern Sydney Local Health District, believes Australian health professionals are well equipped to handle the medical complications, but it is the guidelines and tools to manage the emotional and psychological care that a woman needs that is lacking. Raymond says there are several studies that have asked obese women what they are looking for in terms of support and care throughout their pregnancy and their responses were much the same as any women, they wanted to feel valued, respected and cared about.  March 2013 | 19

specialty focus “These [women] wanted a chance to develop a relationship with one maternity care provider who they trusted, and to be seen as a person and not an obstacle, to be involved with decisions about their care, not to feel humiliated or made to feel like a disaster waiting to happened,” said Raymond. “They talked about ambiguous messages where different maternity care providers gave inconsistent advice about eating or exercise, or never mentioned their weight at all so they got the impression it wasn’t important.” Dahlen agrees, stating that from her experience, women don’t want health professionals tiptoeing around the issue. “The women said ‘we don’t want people tiptoeing around it, we want you to tell it as it is, we need to hear the hard facts but then get alongside us and support us.” Women around Australia with a BMI greater than 35 (sometimes more than 40) are referred to a tertiary centre for pregnancy and birth because of the increased risk of gestational diabetes, high blood pressure and surgical care. Raymond suggests that in these centres “women receive care in a ‘high risk’ antenatal clinic where their care is often fragmented and they will be seen by a large number of different medical staff”. In these environments, sometimes the emphasis seems to be on managing the medical complications that focus on preventative care. There are an increasing number of policies being introduced that recommend women above a certain BMI should be transferred to a hospital with specialist care facilities. Regardless of area, what everyone seems to agree on is that THE EDEN ALTERNATIVE TM Unleashing the power of Person Centred Care through Dementia Beyond Drugs 14th & 16th May 2013 Melbourne The Eden Alternative is aiming to evolve the next generation of care partners to support older people living with dementia. In May 2013, we are offering for the first time, a choice of two 2-day experiential workshops facilitated by Dr G. Allen Power MD based on his award-winning book “Dementia Beyond Drugs” in Melbourne, Victoria. This in-depth learning experience uses the framework of culture change to create a new approach to caring for people who live with dementia. Who should attend? Representatives of and individuals who support people living with dementia in residential, community care and assisted living communities. Workshop 1 - Monday 13th & Tuesday 14th May 2013 Workshop 2 – Thursday 16th & Friday 17th May 2013 Other Eden AlternativeTM education offerings include: • Implementing the Eden Alternative in Aged Care (3 day) open sessions in March, April, September, October 2013 • Community Visitor workshops – (1 day) • Introduction to the Eden Alternative – (1 day) • Open Hearts, Open Minds – (1 day) • Eden Associate Refresher – (1 day) • Eden Registry Master Class – ( 1 day) • Reframing Dementia – (2 day) 20 | March 2013 TO FIND OUT MORE Go to our website: or contact our office +61 3 8819 4732 or email Find us on Facebook/EdenOzNZ

specialty focus models of care need to change in order to successfully care for the needs of this group of women. Case study: SSWInG Raymond was involved in the development and implementation of the innovative St George and Sutherland Weight Intervention Group (SSWInG) in the Sydney South East Local Health District. SSWInG is an integrated model of group antenatal care that provides women who are obese with a one-stop-shop for care throughout their pregnancy – with a particular focus on limiting their weight gain in pregnancy. “[The program] provides pregnancy care, birth preparation, activity and healthy eating information and social interaction all at the same time,” said Raymond. “Women of the same gestation meet as a group (10-12 women) throughout their pregnancy with the same two midwives. There are eight sessions for each group and each last two hours. An optional drop-in session each week provides an opportunity for extra weigh-ins or chat with the midwives. A new group of women starts every six weeks.” To help nor

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