Clinical classifications under review

Association seeks wage increases and allowances.

The NSW Nurses’ Association is seeking wage increases for certain categories of public health system nurses in a review of nursing roles and classifications.

The review was guaranteed as part of the 2004-2008 wages agreement.

The Association and NSW Health are reviewing three classifications – clinical nurse/midwifery specialist (CN/MS), clinical nurse/midwifery educator (CN/ME) and nurse/midwifery educator (N/ME).

The Association is also seeking to create a new classification of advanced practice nurse/midwife to reflect the creation of new roles such as the ‘Clinical Initiative Nurse’ in recent years.

Assistant General Secretary Judith Kiejda said the review provides the Association with a rare opportunity to ensure that nursing classifications in the public health award stay up to date with the needs of the health system.

‘We want to ensure that the new structure encourages recruitment and retention by enhancing the attractiveness of these valuable classifications to members,’ Judith said.

As part of the review the Association is pressing for the continuing education allowance to be paid to CN/ME and N/ME classifications as well as the new classification of advanced practice nurse/midwife.

The CN/MS has already been awarded the allowance as a result of a recent Association win in the NSW Industrial Relations Commission.

The Association’s claim for new Award descriptions is summarised below:

Clinical Nurse/ Midwifery Specialist

  • Appointment by personal grading.
  • Has relevant post-basic qualifications and 12 months’ experience working in the clinical area of his/her specified post-basic qualification, or a minimum of four years’ post-basic registration experience, including three years’ experience in the relevant specialist field.
  • New three-year incremental wage structure (existing Continuing Education Allowance paid in addition).
  • New achievable criteria included in the award description: CN/MS is required to demonstrate at least one criterion listed under headings: Clinical Skill, Professional Behaviour and Professional Development.
  • Current ‘local criteria’ to be abolished.
  • Once deemed competent, a CN/MS will be subject to the usual performance review processes.

The Association also wants other detail included in a supporting policy directive such as examples of the types of criteria to be considered, an acknowledgement that dedicated non-contact time is required for the CN/MS, and that the Department is to monitor the number of CN/MS’s every six months to ensure that clinical service needs are adequately supported.

Clinical Nurse/ Midwifery Educator

  • Has relevant post-registration certificate clinical or education qualifications.
  • New three-year incremental wage structure plus the Continuing Education Allowance paid in addition.
  • Is required to implement and evaluate non-award educational programs at the ward/unit level and performs functions as listed in the description in that ward/unit level.
  • Only provides direct clinical care in emergencies, not routinely to fill shortages.

A supporting policy directive should acknowledge that dedicated non-contact time is required by a CN/ME, promote the importance of the role and availability of the CN/ME to support all clinical staff across all shifts to enhance education and to improve patient care, and for the Department to monitor the number of CN/MEs every six months to ensure clinical service needs are adequately supported.

Advanced Practice Nurse/ Midwife

  • New classification with a single wage rate above CN/MS for nurses who perform independent practice with characteristics such as the Delivery of direct clinical care, Extended autonomy of decision making, and Application of a high level of clinical knowledge and skill.
  • Has relevant postgraduate certificate or equivalent qualification and three years’ experience working in the relevant clinical area, or such qualifications and experience deemed appropriate by the employer.
  • Will provide an additional career pathway towards Nurse/Midwifery Practitioner.
  • Examples include Clinical Initiative Nurses and Team Midwives.

Nurse/ Midwifery Educator

      • New three-grade classification structure with incremental progression within each grade.
      • NSWNA claims the Continuing Education Allowance for qualifications above postgraduate certificate level.
      • Grade 1:
        • to possess postgraduate or equivalent nursing/midwifery clinical or education qualifications relevant to the clinical area, or such other qualifications or experience deemed appropriate.
        • is responsible for the development, implementation and delivery of nursing education programs within an area, group or public hospital.
      • Grade 2:
        • to possess postgraduate or equivalent nursing/midwifery clinical or education qualifications relevant to the clinical area, or such other qualifications or experience deemed appropriate; and
        • is responsible for either a nursing/midwifery education portfolio across a complex hospital, or for a clinical division in a complex hospital.
      • Grade 3:
        • to possess postgraduate or equivalent nursing/midwifery clinical or education qualifications relevant to the clinical area, or such other qualifications or experience deemed appropriate; and
        • is responsible for either a nursing/midwifery education portfolio in a major clinical division or across clinical divisions of a tertiary referral hospital, or across an Area Health Service.

More responsibility– and balancing competing demands

Like all clinical nurse/midwifery educators, Kate Griew seeks to balance her education responsibilities with competing demands to provide a more direct clinical role – especially when wards are busy.

Now, in the midst of a general increase in the number of pregnancies, these demands are intensifying for Kate, a CME at Royal Prince Alfred Hospital who is currently acting as clinical nurse consultant.

‘CMEs are being used to meet staffing shortfalls more often because midwifery units across NSW are experiencing increased workloads,’ says Kate.

‘Many CMEs have to do a majority of clinical work and fit their education work on top of that. As a result we tend to do a lot of education work out of hours, so it is a growing workloads issue as well.

‘I work in the delivery ward and there are many times when they absolutely do need an extra pair of hands.

‘At the same time I know I have to meet my responsibilities for the education component as well. It’s a real challenge to organise your work in those circumstances.’

Kate hopes the union’s claim in the current review of nursing classifications succeeds in delivering both a wage increase and the continuing education allowance to classifications that still don’t receive it.

‘I agree that our responsibility to undertake extra education should be validated and recognised via an allowance. But I would also like to see our additional responsibilities remunerated in the pay scale.

‘The wage itself doesn’t reflect the responsibility and seniority of the position.

‘That may be due to the relatively low priority given to nurse education, plus the fact that the job historically was a lot smaller than what it has become.

‘The job of a midwifery educator used to mainly involve taking students aside and supporting them.

‘The requirements of the job are a lot greater now than when I started seven years ago. The responsibilities are enormous – especially with so many people working part-time.

‘You’re not only supposed to be an expert in your field but you also have organisational responsibilities to maintain quality. You are very involved in regulation and tend to get a bit of everything put on your plate.

‘Resourcing is a big issue – a lot of educators don’t even have offices.’

With a background in general nursing, women’s health and sexual health, and having worked as an educator in family planning, Kate thinks nurses are likely to be attracted to an educator’s role because they love education, not because it’s well-paid – and the hospital system relies on this, she suspects.

‘The fact is you generally drop a very significant amount of pay to become a clinical nurse/midwifery educator because you’re no longer doing shifts.

‘When I first became a CME seven years ago my wage dropped $12,000 to $13,000. Today the gap would be even greater.

‘So I’m very hopeful that the union will get a good outcome from the current classification review.’

NSWNA claims for CNS, CNE and NE rates at 1 July 2007

  • Registered Nurse/Midwife
    • 8th Year – $1232.60
  • Clinical Nurse/Midwifery Specialist
    • 1st Year – $1282.70
    • 2nd Year – $1308.40
    • 3rd Year – $1334.60
  • Advanced Practice Nurse/Midwife
    • $1423.00
  • Clinical Nurse/Midwifery Educator
    • 1st Year – $1308.40
    • 2nd Year – $1334.60
    • 3rd Year – $1423.00
  • Nurse/Midwifery Educator Grade 1
    • 1st  Year – $1499.10
    • 2nd Year – $1577.30
  • Nurse/Midwifery Educator Grade 2
    • 1st Year – $1604.60
    • 2nd Year – $1636.40
  • Nurse/Midwifery EducatorGrade 3
    • 1st Year – $1699.20
    • 2nd Year – $1730.90