More staff on the way

We have won provisions to improve staffing and skill mix, now we need to implement these improvements for safer patient care.

The NSWNA and members fought hard to win nursing hours/ratios and other provisions in the Public Health System Award that give nurses greater control to ensure adequate staffing and skill mix for safer patient care.

NSWNA Assistant General Secretary Judith Kiejda said, ‘We campaigned hard to win these provisions as part of the Award, now they will be progressively implemented in public hospital wards. It’s time for nurses and patients to start reaping the benefits we have won.’

Nursing hours/ratios embedded in the Award

Nursing hours/ratios are now embedded in the award and are enforceable by law.

Implementation of the new nursing hours/ratios system

The new nursing hours/ratios system will be progressively implemented in three tranches in eligible public hospital wards. The selection of wards in each tranche will be agreed by the NSWNA and NSW Health.

NSW Health and the NSWNA are currently meeting to agree on the first tranche of wards that will convert to the nursing hours/ratios system. The selection should be finalised by June to enable recruitment of additional nurses to start.

The NSWNA has been informing members about the new system at information sessions held at hospitals and services across NSW and through phone hook-ups with Branch Officials.

NSW Health is also meeting with DoNs at public hospitals to explain the new system.

Recruitment of additional nursing positions

Around 1,400 additional FTE nursing positions are currently required to implement the new nursing hours/ratios system. Recruitment will be in three tranches:

  • Tranche 1. Around 450 new FTE nursing positions will be recruited by 1 July.
  • Tranche 2. Around 450 new FTE nursing positions will be recruited in two phases – phase one by 1 Feb 2012; phase two by 1 July 2012.
  • Tranche 3. Around 450 new FTE nursing positions will be recruited in two phases – phase one by 1 Feb 2013; phase two by 30 June 2013.

NSW Health is currently advertising for new FTE nursing positions online, and has already received more than 300 Expressions of Interest (EOIs). The Department is referring the EOIs to the Local Health Networks for interviews and selection.

Selection will follow normal recruitment processes. To avoid delays, the NSWNA has asked NSW Health to investigate using a block recruitment process rather than the e-mercury electronic recruitment process.

FTE positions will be also filled as nurses working on a part-time and casual basis convert to permanent FTE.

As soon as interviewing and selection has been completed, the additional nurses will be placed on the first tranche of wards selected to convert to the new nursing hours/ratios system.

Where we have won ratios

  • Surgical/medical wards.
  • Palliative care units.
  • Rehabilitation units.
  • Acute adult inpatient mental health units.

Improvements to patient care and patient flow

Sharon Townsend, NUM in the Medical Oncology ward at Wagga Wagga Base Hospital, is thrilled to have minimum nursing hours/ratios laid out in the Award.

‘It’s certainly a good thing to have minimum staffing laid out in the Award. With the implementation of minimum staffing as per the Award provisions the Nursing Unit Managers will be able to communicate with hospital management regarding nursing numbers to facilitate safe patient care.’

On Sharon’s ward, the pivotal provision that will have the greatest impact on improving patient care is having the ability to roster an additional in-charge nurse after hours.

‘It will make a big difference having a senior RN rostered when the NUM is not on duty, whose role focuses on directing patient care. If an in-charge nurse has a patient load, this detracts from patient care. For me, this is the most significant part of what we’ve gained. This will improve patient care and facilitate patient flow,’  said Sharon.

More resuscitation nurses for EDs

We have won funding for an additional 188 full-time equivalent positions in Emergency Departments (EDs).

This means a 1:1 resus nurse ratio for the EDs with more than 45,000 UDG presentations per year and dedicated nurse positions for resuscitation beds in EDs with more than 25,000 presentations.

Implementing resus nurses for EDs

The NSWNA and NSW Health are currently assessing how many resus nurses are required for each hospital ED that qualifies under the Award commitments. The additional positions in EDs will be implemented in five tranches:

Tranche 1: May and June 2011

Tranche 2: 1 July 2011

Tranche 3: 1 February 2012

Tranche 4: 1 July 2012

Tranche 5: 1 February 2013.

Replacing absences with like classifications

The Award includes a provision that all unplanned absences should be replaced with like classifications. The requirement for nurses to be replaced with like classifications is effective immediately. This requirement applies to all clinical areas, not just nursing hours/ratios wards.

Make sure we get ‘like for like’

Karen Fernance, NUM in the Cardiology Unit at Bankstown Hospital, is determined to see the ‘like for like’ clause for replacement staff implemented.

Like many hospitals, it’s a significant problem at Bankstown Hospital that AiNs are being used to replace ENs or RNs for short-notice leave. So Karen is pleased a new ‘like for like’ clause has been included in the new Public Health System award, which provides that unplanned nurse vacancies should be backfilled by nurses of the same classification for the full length of the shift.

‘Generally replacement staff come from a pool of undergraduate RNs who are AiNs. It’s particularly problematic when Cert III AiNs are used to replace ENs or RNs,’ said Karen.

‘Now we have a clause in the Award stating that nurse vacancies should be backfilled by nurses of the same classification, I started thinking how we could start to immediately address the problem.’

Karen approached the NSWNA for help developing a standardised template that shows how we can do this.

‘If the like-for-like provision is not being met, raise it with your Branch, and then the Reasonable Workloads Committee at your hospital,’ Karen said.

‘There’s going to be some trial and error. The implementation is going to be through a negotiation process. We need to be proactive and work through the Reasonable Workloads Committee to make sure nurses get the benefits of the new “like for like” Award provision.’

Perioperative Services

ACORN 2008 standards will be implemented in Operating Rooms. The minimum staffing in each theatre will be two nurses: one must be an RN; the other may be a suitably qualified EN. In addition there should be one Anaesthetic nurse (or their equivalent).

Control and flexibility to ensure we have enough trained staff

Kerry Rodgers, NSWNA Councillor and NUM working in the operating suite at Nepean Hospital, said the new Award provisions will give NUMs greater control and flexibility in regard to rostering, with the ability to ensure enough adequately trained staff are working on each shift.

‘For a NUM in the perioperative environment, the ACORN 2008 standards ensure NUMS can roster enough adequately trained staff for safe patient care. Also we’ll have the flexibility to utilise them to where they are needed,’ said Kerry.

The extra staff will mean NUMs can ensure better support for transitional nurses and beginning practitioners.

‘The new standards will make a huge difference in how operating suites will function. For nurses on the floor, the provisions mean the environment is less stressful and they will have greater job satisfaction. The Award provisions expand the scope of practice for ENs who have higher-level specialist qualifications,’ said Kerry.

A key factor to the success of implementing the new provisions is that the standards are enforceable.

‘We are able to hold management to account. It means we can ensure we get the staffing entitlements we fought for because we have the backing of the Award,’ said Kerry. ‘As a perioperative NUM, if there are not enough competent, adequately-trained staff rostered on, we would inform management that we won’t be able to safely run that room. This applies across the perioperative environment, from theatres to recovery and day surgery.’

Birthrate Plus

Roll-out of Birthrate Plus will commence in June this year and must be finalised by June 2012. The timetable for implementation of Birthrate Plus can only be varied by agreement with the Union and is as follows:

  • By the end of June 2011, Maternity Services with completed Phase 2 data collection and where the models of care remain unchanged.
  • By the end of December 2011, Maternity Services with completed Phase 2 data collection and where changes to the models of care require review, including possible further data collection.
  • By the end of June 2012, Maternity Services that are of sufficient size to utilise Birthrate Plus and were not part of Phase 2 data collection.

See the April issue of The Lamp or the NSWNA website ( for detailed information about Birthrate Plus.