Advancing the nursing profession

Academics and leaders from international nursing unions addressed this years` NSWNA Professional Issues Conference about a range of issues concerning the advancement and protection of the nursing profession.

NZ nurses put pay equity at heart of pay campaign

The right of women to have incomes and job choices that are not constrained by gender discrimination and gender expectations is a big idea and we should not be afraid of it, according to Laila Harre of the NZ Nurses Organisation (NZNO).

Laila outlined the NZNO national campaign for fair pay and safe staffing which recently achieved significant gains for NZ nurses after 10 years of fragmented bargaining under the Employment Contracts Act, and 15 years of continual health service restructuring.

‘Through actively building trust and confidence in each other’s resolve to make a lasting difference, nurses and midwives overcame the suspicions implanted by years of divide and rule,’ she said.

A key argument used by the NZNO for the pay increase was pay equity – to overturn the historical undervaluing of the large, highly skilled and mainly female occupation of nursing.

‘This led to a $700 million commitment from the government in the budget for the implementation of fair pay,’ said Laila.
She said a major challenge for the NZNO during the campaign was overcoming the low expectations of nurses.

‘The sense of duty – expecting little but the reward of the job well done – won’t sustain our profession at a time when we need to attract well-educated young people to start a lifetime career. Governments and employers thrive on low expectations.’

The future of enrolled nursing in a training package world

Readers may recall the report in the October Lamp describing NSWNA concerns that EN qualification will be undermined by a proposal to transfer EN training from the current TAFE qualification to a National Health Training Package. Dr Chris Manwarring explained the implications of incorporating EN training into the National Training Package from her perspective as TAFE Program Manager Health and Aged Services.

The proposal to replace the current TAFE qualification with a set of ‘competency standards’ for ENs outlined in a National Health Training Package derives from a recommendation by the National Review of Nursing. The Health Training Package is being developed and will be maintained by the Community Services and Health Industry Skills Council.

A Training Package identifies the specific roles of an occupational group, eg dental technicians, and comprises core units of competency and elective units.

A draft framework for the EN qualification was released in August for comment from the nursing profession.

Dr Manwarring said the move to replace the EN qualification with a Health Training Package aims to accommodate the needs of industry employers. Under the package, EN training will be targeted to workplace needs.

‘A Health Training Package qualification will provide national consistency in EN training and education, national consistency in the qualification level (it currently varies across the states) and scope of practice for ENs.

‘For nurses it means they can obtain national recognition of their skills. They can receive on-the-job training where their existing skills can be recognised. It may mean a broadening of career pathways in the health industry.

However, Dr Manwarring raised concerns about the structure of the health training package. ‘There is inconsistency in the number of core and elective units of competency of the Health Training Package qualifications. There is significant variation in number of units required for different qualifications at the same level,’ she said.

‘Training package qualifications do not specify the duration of the training nor the teacher qualification or delivery mode.’

The Industry Reference Group – set up to provide advice on a framework of core and elective units, priority areas for industry skills development based on the job role, industrial issues, and regulatory and licensing issues – raised concerns about the draft framework for the qualification.

‘The Industry Reference Group believes the units must be specific to the enrolled nurse role. The qualification needs to have nursing in its title and the specific units must have nursing in their name and be delivered in the context of nursing where appropriate to prevent other workers adopting the role of a nurse.

‘It is important the units from a Certificate IV qualification are embedded into the Diploma to ensure consistency in knowledge and skills, allow portability of the EN qualifications and provide a pathway from Certificate III to under-graduate programs,’ she said.

Surviving shiftwork

Shiftwork is a loathsome aspect of the nursing that’s almost impossible to avoid. Research psychologist Dr Delwyn Bartlett shared some tips with conference delegates on how get more and better sleep when you’re caught in the shiftwork zone.

When you’re working nightshift it may seem that everyone else is off having a good night’s sleep. But you’re not alone. Around 20% of workers work nightshift, said Dr Bartlett.

‘When you are working nightshift you lose around five to seven hours’ sleep per week,’ she said. ‘Twice the number of accidents happen on nightshift than dayshift and nightshift workers are more vulnerable to car accidents on the way to and from work.’

So how much sleep do we need? Around 7-8 hours said Dr Delwyn. However, some people need as little as 4 hours per night, and others need 10 hours.

According to Dr Bartlett, shiftwork means you are working against your body’s natural rhythm. ‘Shiftwork is very stressful. You are pushed into a state of hyperarousal,’ she said.

‘When you are stressed muscular tensions increases, memory can be affected, you become moody, you can suffer stomach upsets and diarrhoea, more frequent illnesses like colds and flu and sleep disturbance is common.

‘In extreme cases individuals suffer from a clinical condition called shiftwork sleep disorder (SWSD) where they cannot maintain a normal sleep duration despite attempts to optimise environmental conditions for sleep. Around 2-5% of shiftworkers are thought to suffer from SWSD.’

To maximise sleep after a nightshift, Dr Bartlett recommends you wear dark sunglasses with side shields on the way home from work. ‘The darker the better but you need to be able to see.’

‘Go home and get into bed as soon as possible. Avoid doing anything else.

‘Make your sleep environment as dark as possible. Use black plastic bags on the windows if need be and have background white noise like a fan. Keep your bedroom cool. Don’t forget to pull out the phone and leave a note on the front door telling all callers that you are sleeping.’

Whether you’re working nightshift or not, Dr Bartlett has some tips for a better night’s (or day’s) sleep:

  • Use your bed for sleep and sex only
  • Get out of bed if you haven’t fallen asleep after 20 minutes. Sit on the floor for five minutes then get back in to bed.

‘If you are not sleeping well it is important to check out whether you have a sleeping disorder such as insomnia, restless legs syndrome, obstructive sleep apnoea,’ said Dr Bartlett. ‘It’s also important to check out the possibility of other medical conditions or psychological disorders.’

Sleep can be disturbed by increased stress. Disturbed sleep also predicted by increased work demands, high physical workload, being female aged over 45 years and having a high body mass index.

How you think is how you feel, warns Dr Bartlett. ‘Negative thoughts can keep you awake so it’s important to distract negative thoughts in bed. Focus on something calming and try to think realistically about sleep and being awake at night, instead of catastrophising about the consequences of not sleeping.’