Update Aug 2018

AUGUST 2018
IN THIS ISSUE:
TOGETHER
WE CAN
CHANGE
THE RULES
SEE PAGE 12
Connect with us

STRAP YOURSELVES
IN, IT’S FULL
STEAM AHEAD…
August has certainly been an action-packed month!
Our 2018 Annual Professional Conference and Annual
Delegates Conference, both held at our very own
conference centre, started us off in exceptional form.
We have covered some of the key presentations in this
month’s news. These articles only touch the surface
of the powerful and stimulating presentations we
experienced over the three conference days. Feedback
from participants has been overwhelmingly positive, and
we are presently seeking formal feedback to help us plan
an even better event next year.
Also last month, the Chairs of the Boards for each of the
metropolitan Local Health Networks were announced,
signalling the start of the transition to new governance
arrangements for our public health system.
Consultation continued over the services to be provided
at Modbury Hospital in the North and commenced over
future uses of The Repat site in the South. Although there
are very different options and issues being considered
in both cases, there are similarities that need to be
addressed. These common considerations include
patient safety, co-requisites in facilities and services, staff
availability to meet the service requirements and the
impact on other services in the relevant regions. We will
continue to make submissions to those reviews that focus
on meeting the needs of the community within a safe and
cost-effective model of care.
Central Adelaide Local Health Network announced it had
engaged consultancy firm Korda Mentha to help it meet
its recovery plan, to address the current and projected
budget deficits and performance issues. We have met
with CALHN and the consultants and will make positive
contributions aimed at ensuring that the new hospital is
as effective and efficient as it can be into the future.
Our aged care campaign to secure safe staffing levels and
skill mix has continued with an increasing focus on the
forthcoming federal election due in the first half of 2019.
From now until election day, we expect to campaign for
commitments to legislate for minimum staff-to-resident
staffing levels and an increased proportion of registered
and enrolled nurses to meet the increasing needs of aged
care residents in the years ahead. We will be moving into
a period of increased public and community campaigning
in the weeks and months to come, particularly in the
federal electorate of Boothby; the state’s most marginal
seat. Look out for opportunities to play an active role in
that campaign.
I have continued with my own workplace visits program as
part of my personal commitment to be ‘with you at work
and in practice.’ I continue to value these visits highly -
meeting with you is not only inspiring and informative,
but also serves as a way to ensure that our services and
advocacy are meeting your needs as members.
As with most months, August has presented us with
both opportunities and challenges. We will continue to
work with you in order to capitalise on opportunities
and address the challenges in the interests of providing
effective health and aged care services to the public in the
years ahead.
Adj Assoc Professor Elizabeth Dabars AM
2

THE ROLE OF NURSES IN
THE WORKFORCE OF
THE FUTURE
Do you agree with either of the following statements?
a. Nurses can take on many of the roles traditionally
undertaken by doctors, delivering equal or
improved quality of care at a lower cost.
b. Much of the work currently undertaken by
registered nurses can be undertaken by less
qualified unregistered professionals.
Canvassing audience responses to the above
propositions was how international health workforce
researcher Professor Peter Griffiths kicked off his
keynote presentation at this year’s Australian Nursing
and Midwifery Federation (SA Branch) Annual
Professional Conference.
Attendees overwhelming agreed with the first statement
but less so with the second—a result that didn’t surprise
Professor Griffiths.
“Nurses rarely have much problem endorsing that they
can take on the role of doctors but are less inclined
to agree that they can be replaced by someone less
qualified,” he says.
A clinical nurse by background, Professor Griffiths
has worked closely with UK and international health
policy makers in a number of capacities and is currently
Chair of Health Services Research at the University
of Southampton. His long history of health services
research has largely focused on the nursing workforce
and skill mix.
“When we talk about the staffing and skills mix of the
nursing workforce, we’re talking about the quality of
care and ultimately matters of life and death for the
users of a healthcare system.”
“There’s only one objective around professional
advancement and that is whether it provides better care
to your patients.”
“The quality of health care being delivered to people
should be the pre-occupation of researchers and
workforce planners.”
He says that over optimistic reactions to some positive
early research on an experimental nurse-led inpatient
ward led to newspaper headlines such as ‘Doing Away
with Doctors.’ Although the case for nurses to have a
greater role in patient care was strengthened by the
findings of a 1995 report, later findings, including his
own, gave much more reason for caution.
“There’s a real danger to patient outcomes if we’re led
by unconfirmed research, even if it appears to be telling
us what we want to hear.”
Although there is evidence that nurses can safely
substitute for doctors in some health settings, in primary
care for example, evidence on cost effectiveness is often
lacking.
“While there is hugely influential research
associating nurse staffing levels with patient safety
in acute environments, the skill mix of staff has been
subsequently proven to be a key factor.”
He said nurses (and midwives) can substitute for doctors
under some circumstances but this does not necessarily
equal cheaper care, although in primary care it seems
that nurse-led care costs no more and might save
money while still improving quality.
In the same way, there is also no evidence to suggest
replacing Registered Nurses with Assistants in Nursing
drives cost-efficiencies. In fact, there is some evidence
emerging that suggests it might cost more because
outcomes are not as good.
And economic arguments are influential when you
consider the growth of the healthcare workforce.
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“The delivery of healthcare is labour intensive and is
not reducing despite changes in technology.”
In England alone, its public health service (the NHS)
employs 1.2 million people, around 40% more
employees than 20-plus years ago.
Looking at studies on the links between nurse staffing
levels and outcomes of hospital care, including death
rates, Professor Griffiths said, unsurprisingly, increases
to total staffing levels cost more money.
“If you calculate the ‘cost per life saved’ from economic
studies of increases in nurse staffing, you get a range of
figures depending on what changes are proposed and
where the study was done. Apart from one well known
Australian study, these results don’t necessarily look
like good value, but we have to remember that costs in
the US are very different and there is much more ‘value’
from improved nursing care than reduced death rates.
Ultimately, Professor Griffiths says the best value for
money, based on all evidence, is achieved by improving
the skill mix while keeping the same number of nurses.
Although higher skilled staff cost more, the increased
costs are more than offset by savings from improved
care, for example, reduced hospital stays.
He also says it’s vital for hospital managers to be able
to experiment and innovate, provided they have an
evidence base to guide any proposed changes.
Also linked to the failings at the Stafford Hospital
was management’s decision to replace a number
of Registered Nurses with more junior Assistants in
Nursing.
“We don’t yet know what the best or the right skill
mix is, but we do know the value of highly skilled
practitioners.”
And when it comes to their role in the future, both
professions—nursing and medical—must be able to
adapt to future demands.
“Whether we have doctors and nurses as we currently
know them in the years ahead, we do need to be
assured that all professions are well trained to deliver
high-quality care.”
“If we focus on training them for today’s healthcare
needs and enable the workforce to continue to learn
and adapt we will produce a workforce fit for the
future.
“And nurses have a vital role in the future of healthcare
no matter what that future looks like. I certainly hope
that future is one where professional nurses are still
delivering ‘hands on’ nursing care because that’s where
we know they can deliver the most benefit for patients
and the best value for the health system.”
“We wouldn’t introduce a new drug without evaluating
its effectiveness, but we seem all too willing to do this
with our practitioners.”
One tragic example he cites was the decision by a UK
hospital to reconfigure its wards onto three floors which
has been linked to up to 1200 unnecessary deaths.
“Finance was considered to be a crucial factor to move
those wards—and there seemed to be no evidence
base to do so.”
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ANNUAL PROFESSIONAL CONFERENCE 2018

NURSE
PRACTITIONER
ROLE “THE
BEST OF BOTH
WORLDS”
FOR JASON
A burning desire to do more for his patients was
the driving force behind Jason Walters’ 20-year
quest to become one of South Australia’s first Nurse
Practitioners.
“I’d been working as a Registered Nurse, primarily in
acute emergency settings, when I started my advanced
practice training,” Jason says. “It was back in 1996 when
there was a lot of talk about Nurse Practitioners but no
real clarity about what the role actually meant.”
“I always had an interest in emergency care and found
myself thinking ‘I could be doing so much more to
help my patients’ beyond the scope of practice of a
Registered Nurse’.”
“Outpatients would come in and you’d know what they
needed, but you’d have to wait for one of the doctors to
do it.”
He says he had no interest in pursuing a career in
medicine.
“I never wanted to be become a doctor and still don’t,
but certainly wanted to see how much more I could do
in nursing.”
“I moved into management for seven years, but I felt
the administration side of things detracted me too
much from the clinical care work that I loved.”
As a prerequisite to his advanced practice studies,
Jason had completed a graduate diploma in emergency
critical care, covering areas such as cardiac care,
trauma management, suturing, plastering and x-ray
interpretation.
Next, he undertook Masters studies (including more
than 5,000 hours of advanced practice), graduating in
2013.
Three years later, Jason became one of South Australia’s
first nurses to be endorsed and credentialled for both
public and private sector to operate within the broadest
scope possible within the profession.
Study steps to becoming a Nurse
Practitioner
1. Bachelor of Nursing degree – 3 years
2. Graduate diploma – 2 years
3. Masters – 3 years and 5000 hours of
advanced practice experience
“I’ve been an endorsed and credentialled Nurse
Practitioner since 2016,” he says. “I can admit, prescribe
and discharge. I see everything, I assess everything and
then I work out which patients I can manage myself,
who needs to go to a specialist and who needs a GP to
look after their overall care.”
Jason is now one of South Australia’s only Nurse
Practitioners credentialled to perform the role both
in an acute setting, at the Lyell McEwin Hospital
emergency department, and as a private fee-for-service
practitioner in regional South Australia.
“At the Lyell McEwin Hospital, I work within the
within the scope of an emergency department Nurse
Practitioner and as a generalist practitioner with a much
broader scope of practice in the Riverland.”
“I largely balance my time between the Lyell
McEwin and private clinics,” he says, adding, “I’m
also credentialled to work as a Nurse Practitioner
at Karoonda Hospital and Mannum Hospital in an
emergency and general primary health capacity.”
“I handball things when they’re too complex, and when
they’re out of scope or outside of my comfort zone I
seek advice or refer the patient to a specialist.”
5

Setting up a collaborative arrangement with a medical
practitioner is a requirement to access Medicare billing
and PBS prescribing in a private capacity.
“You have to get a good supportive general practice
behind you. At least in that collaborative arrangement,
have someone who’s going to teach you and support
you.”
“I used to call my collaborative GP partner every day
for advice, but now I’d be lucky to ring him once a
fortnight.”
“If patients have more complex health issues and have
multiple systems going on, I’ll tell them I’m happy
to share their care, but they’ll need a GP to oversee
their whole care. For example, if I saw someone with
renal failure, hypertension, diabetes and chronic heart
disease, I would be happy to give them a script and
refer them to a specialist.”
He says the barriers he once faced for essentially sitting
‘between camps’ are now starting to break down.
“Some medical staff felt threatened by the increased
scope of practice of a Nurse Practitioner, and some
needed reassurance that I wouldn’t be competing with
them, which is understandable.”
“I’m not here to replace a doctor, I do my
own thing.”
Jason says some practices also used to knock back his
referrals for services.
“Occasionally I would get a call from a medical practice
manager questioning whether my provider number
was real, as they were concerned they weren’t going
to get paid by Medicare. There aren’t a lot of us in the
state, and it’s a relatively new system, so many practice
managers hadn’t come across the role and its scope.”
“Many doctors know me now and they know what I’m
capable of, so those issues—for me at least—are largely
a thing of the past.”
In fact, Jason now provides education and training in
emergency medicine for rural GPs, paramedics and
nurses.
It is this diverse mix in his working life that Jason loves
most.
“I wanted to keep my hand in emergency care at Lyell
McEwin Hospital, so I work there part-time,” he says.
“But I also do four education sessions a month, work
fortnightly at Karoonda Hospital, have bulkbilling clinics
in Barmera each month and I’m the only visiting health
practitioner servicing Morgan each week.”
“It’s challenging, it’s fulfilling, and it really does give me
the best of both worlds.”
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6

JULIA GILLARD SHINES A
SPOTLIGHT ON NURSES’
AND MIDWIVES’ MENTAL
HEALTH AT ANNUAL
PROFESSIONAL CONFERENCE
Tears were shed at this year’s Australian
Nursing and Midwifery Federation (SA
Branch) Annual Professional Conference as
Australia’s 27 th Prime Minister delivered a
powerful address on a topic close to us all.
Speaking in her capacity as Chair of mental health
advocacy organisation beyondblue, Ms Julia Gillard AC
shared some fond childhood memories of her father’s
nursing work as well as the harsh realities of today’s
mental health issues, particularly among nurses,
midwives and other health professionals.
“As professional nurses or midwives, you’ve dedicated
your lives to supporting others. It’s rewarding work.
You do it because you love it, you do it because you
care. We all need to accept, however, that this is
physically, intellectually and emotionally demanding
work,” Ms Gillard said.
“Compared to the general population, nurses
experience higher rates of stress-related health
conditions, including psychological issues.”
In the wider community, eight Australians die by
suicide every day with around 200 people attempting
to kill themselves every day.
“Suicide rates for female health professionals,
including nurses, are higher than for women in
other occupations. Suicide rates for male nurses and
midwives were significantly higher than for men
working outside the health professions.”
She said nursing can take a personal toll, referencing
burnout, compassion fatigue, secondary trauma and
vicarious trauma. She stressed that, as nurses and
midwives, self-care should be practiced as an essential,
not optional, part of everyday life.
She highlighted the importance of healthcare
professionals being able to recognise mental health
‘red flags’ and employing certain strategies and support
systems to maintain their mental health.
“At beyondblue we often remind people that they can’t
look after someone else unless they’re looking after
themselves,” said Ms Gillard.
Ms Gillard drew upon the findings of a 2012 study
conducted by the Nursing Research Unit at King’s
College in London to explain that if nursing staff had
a positive, supportive working environment, patients
were more positive about the care they received:
“When nurses feel good, patients feel better.”
Risk factors for adverse mental health conditions
include:
• Shift work and disrupted sleeping
patterns
• Occupational violence or
aggression from the public
• Repeated exposure to death and
trauma
• Conflict between work
obligations and family obligations
• High levels of responsibility
• High expectations from the community
• Greater access to lethal means in
the case of suicide risk
• Fear of making mistakes
“Despite these clear risks, few Australian health
services have adopted sustainable workplace mental
health and wellbeing strategies—we want to change
that.”
She says the task of improving mental health of
healthcare professionals is twofold.
Firstly, individuals must be supported in their
understanding and maintenance of their own
7

mental health. Strategies such as eating regular meals,
developing interests beyond work, identifying triggers
of stress and trying relaxation methods can all lead to
improving mental health.
Secondly, institutions of health and care must strive to
emulate good mental health practice by encouraging
conversation around the topic of mental health and
activating resources that provide employees with help
when they need it.
She explained how her father’s work as a psychiatric
nurse in Adelaide’s Z Ward had allowed her to see how
far Australia has come in its approach to the stigma and
discrimination that surrounds mental health discussions.
Both our understanding of mental health and access to
a growing number of relevant resources, she said, have
improved since the days of the Z Ward.
“In Australia, it’s true that we’ve come a long way in
putting people first when deciding matters involving their
own care,” said Ms Gillard. “People are more prepared
to discuss and act on their own mental health than ever
before.”
Ms Gillard encourages nurses, midwives and personal
care workers to pursue supportive mental health
practices in the workplace by challenging their
supervisors and leaders to employ mental health help
strategies and having open discussions with their
colleagues about mental health to help reduce the
stigma that surrounds it.
“People that get help, get better.”
View Ms Gillard’s presentation in its entirety
here.
8
ANNUAL PROFESSIONAL CONFERENCE 2018

AGED CARE STAFFING CUTS
HIT MOUNT GAMBIER
Australian Nursing and Midwifery Federation (SA
Branch) is supporting Boandik Lodge members after
staffing cuts were announced at its St Mary’s aged
care home in Mount Gambier.
According to an ABC News report, the not-for-profit
aged care provider has cited inadequate government
funding and rising costs for cutting the shift hours of its
staff.
The facility is not the first in the nation to slash jobs
and, without federal government intervention around
funding and staffing, it won’t be the last.
ANMF (SA Branch) CEO/Secretary Adj Assoc Professor
Elizabeth Dabars AM told ABC Radio that cost-cutting
measures are being taken by many facilities across the
nation.
“There is a broader question around the management
of these facilities, around whether people are spending
their money in the right areas, are they investing the
money in the right places?”
She references the ANMF-commissioned report which
uncovered numerous for-profit providers that are
paying very little, if any, tax and accruing an enormous
amount of profit.
“There is no relationship between the money given [to
these facilities] by the federal government and the care
delivery in these aged care facilities,” Ms Dabars says.
“There is no requirement to spend it in a particular way,
there is no tying of that funding into care delivery.”
She says, as a society, we need to consider the
consequences of not investing more in aged care.
“There are costs involved in quality care. But, equally,
we as a community have to make decisions around
what do we want, for ourselves, for our grandparents.”
“In the broader context, we know staffing numbers and
skill sets are not adequate across the aged care sector
and residents are being left extremely short in terms of
their care.”
She says ANMF (SA Branch)’s independent research
revealed that, on average, an aged care resident
needed at least 4 hours and 18 minutes of care each
day, yet the average being given is just 2 hours and 50
minutes care.
“People are missing out on having their care needs
met.”
She says, while the needs of aged care residents have
risen by 40 per cent in recent years, staffing numbers in
the sector have reduced by 13 percent.
“Nursing staff are run off their feet doing all they can in
impossible circumstances.”
ANMF launched its national campaign calling on the
federal government to introduce legislated staffing
ratios in aged care. If you haven’t yet pledged your
support, add your name to the growing list at
www.morestaffforagedcare.com.au
Listen to the entire media interview here.
9

WORKFORCE RENEWAL
- EQUIPPING THE
WORKFORCE OF
THE FUTURE
South Australia is set to lose up to half of its nursing
and midwifery workforce to retirement over the next
decade. And with this significant loss of nurses and
midwives, many of whom are leaders in their current
roles, our public health system will lose an abundance
of knowledge around clinical practice, management
and education.
Equipping the next generation of nurses and midwives
with the skills, and indeed the roles, to provide highquality
care well into the future has been a key focus for
the ANMF (SA Branch).
“We’ve been working with SA Health to reach
agreement on a workforce renewal plan since the
last public sector enterprise agreement in 2016,” says
ANMF (SA Branch) CEO/Secretary Adj Assoc Professor
Elizabeth Dabars AM.
“The staffing challenges ahead called for a renewed
focus on workforce planning and development, as well
as a greater focus on recruitment, retention and the
acquisition of knowledge and skills to meet the needs of
the health and aged care systems as we move forward,”
she says.
ANMF (SA Branch) has played a pivotal role in
finalising a strategy to support this renewal across
South Australia’s public sector nursing and midwifery
workforce.
“We are thrilled to have reached ‘in principle’
agreement of some of the main elements of the plan,
while we wait for the Australian Taxation Office to
provide the final tick of approval,” Ms Dabars says.
In its current form, the proposed workforce renewal
scheme will be open to Registered Nurses/Midwives
levels 1 to 3.
“The plan provides for up to 100 (FTE) $50,000
incentive payments to be offered to selected level 1
or 2 Registered Nurses/Registered Midwives upon
retirement this year, provided they meet all of the set
criteria.”
10

Eligible nursing/midwifery staff must:
• be over 60 years of age as at 1 October 2018;
• have more than 10 years’ service with SA
Health as at 1 October 2018;
• not work in an area of identified skills shortage;
• be substantively classified or have a right of
return to an RN/M1 or RN/M2 in-scope clinical
position; and
• be able to be replaced with an RN/M level 1,
year 1 or 2.
Subject to final approval, calls for interested and eligible
candidates will take place from October to December
this year to maximise the potential for Transition to
Professional Practice Program (TPPP) participates to
assume the available roles.
Further, as a proposed way of fostering the transfer
of knowledge between outgoing staff and younger
nurses and midwives, up to 15 level 3 Registered
Nurses/Registered Midwives will be able to nominate
to participate in a coaching program to span March to
December next year.
payment on completion of six months’ coaching of a
replacement staff member,” Ms Dabars says.
The coaching program will require the level 3 RN/M
to work on a reduced-hours basis (half-time) and
effectively job-share their role with the person selected
as their ultimate replacement.
Areas and positions will be earmarked for workforce
renewal by the respective Executive Directors of
Nursing and/or Midwifery.
“ANMF (SA Branch) is also looking at ways of addressing
the workforce shortage in various areas of clinical
specialisation, which are already finding it difficult to
attract and retain skilled staff,” Ms Dabars says.
“Undersupply is emerging in areas such as critical care,
peri-operative nursing and mental health. Outside
the metropolitan area, midwifery is also experiencing
difficulty in attracting appropriate staff.”
“ANMF (SA Branch) is pleased to have played a key role
in developing a scheme that will enable the workforce
of the future to meet the anticipated growing demand
for care and treatment in areas of acute care, primary
health services and aged care.”
“The program will ultimately lead to them being eligible
to retire from their role and receive the $50,000 (FTE)
11

TOGETHER
WE CAN..
Australians are currently facing a working landscape
that has seen both dramatic growth and frustrating
stagnation over the past few decades, ACTU President
Sally McManus explained to Australian Nursing and
Midwifery Federation (SA Branch) Annual Delegates
Conference earlier this month.
“Both income inequalities and wealth inequalities have
increased,” she said. “This is a very different type of society
than the one that we, as union members, have fought
for over a period of time.”
She says the problems are rooted in the use of ‘trickle-down’
economics which theoretically see workers earn
more as those at a higher level earn more.
However, after 30 years, all that trickle-down economics
has been able to produce is inequality at a 70-year high,
more insecure work and record low wage growth.
“The economists say it’s weird, they don’t know what’s
going on. Profits are going up, productivity is going up,
but wages are staying the same,” said Ms McManus.
“What they don’t understand is what we all know:
employers will give pay increases when the law requires
them to.”
And that’s the problem the Australian Council of Trade
Unions (ACTU) is currently trying to tackle with the new
‘Change the Rules’ campaign. The idea is to update
legislation surrounding wages and workers’ rights in an
attempt to address the inequality that currently upsets
the workforce.
To improve Australian working conditions, Ms McManus
says the government needs to focus on tax law reform
and increased bargaining powers for employees.
Currently, around 732 big companies do not pay tax in
Australia and instead use their resources to find ways
around paying tax. The Turnbull government believes this
will encourage companies to increase worker pay and
employment numbers.
“This is classic trickle-down economics,” argues Ms
McManus. “But the thing is, there’s been 30 years of this
experiment and it hasn’t worked because they’ve kept it.
They’ve kept that money.”
A gradual change of laws has also seen employees slowly
lose their ability to influence terms of their employment,
such as job security, renewed contracts and pay rates.
Ms McManus says that workers are no longer able to
enforce their rights and keep their employers in check
without engaging in long and expensive legal processes
that may not even be successful.
“It’s one thing to have rights, it’s another thing to
enforce them, and that’s how we get basic fairness.”
Her sentiments are not just of a union but indeed
have been echoed by major non-government organisations
such as St Vincent de Paul Society.
In presenting his opinions on the current structure of
the Australian workforce at the recent ACTU Conference
in Brisbane, ‘St Vinnies’ National CEO Dr John
Falzon also painted a picture of growing wage disparity
and struggle between the wealthy and the people
without power.
“I’ve listened hard and I’m yet to hear the sound of
the wealth trickling down. What I hear is the sound of
the excluded still waiting,” Dr Falzon said.
Ms McManus ended her address encouraging nurses,
midwives and personal care workers to ensure they
are engaged in the terms and conditions of their
employment and in actively working as a collective
towards a fairer future.
“We’ve always seen ourselves as the country of a fair
go, of egalitarianism, but that’s been slowly ebbed
away over time.” Ms McManus said.
It’s time to Change the Rules.
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