NSWNMA branches at the state’s public hospitals and community health centres start voting today, 18 February, on a proposed staff ratios and wages claim that challenges the O’Farrell Government to build on the safer hospital staffing levels introduced in 2011 under an agreement between the NSWNMA and previous Labor government.
Branches that have advised they will vote in the next few days are:
Monday, 18 February
Maitland Hospital – 11.00am ballot opens
Maitland Mental Health – 2.30pm
Lower Hunter Community Health Centres cluster – 2.30pm
Tuesday, 19 February
Royal Hospital for Women, Sydney – 12.30pm
Nepean Hospital – 2.30pm
Blacktown Hospital – 2.30pm
267 NSWNMA branches, representing more than 33,000 public-sector nurses and midwives throughout NSW, are eligible to vote.
Branches must vote by 4.00pm Friday, 1 March. If approved by a majority of the branch vote, the NSWNMA will then seek to have the claim incorporated into the new Public Health System Nurses & Midwives (State) Award, which replaces the current award when it expires on June 30 this year.
A key feature of the claim is guaranteed, safer nursing levels for seriously ill children, emergency departments and rural hospitals and multipurpose services, and safer nursing and midwifery staffing arrangements in community health services.
The claim also includes two 2.5 percent per year payrises, which will provide the majority of experienced, full-time nurses and midwives with a payrise of more than $70.00 per week, or more than $3800.00 per year, by July 2014.
The first television advertising, in support of the claim, has already been run around the state.
The current award, which was finalised in February 2011, included the first stage of a major reform of staffing arrangements in NSW public hospitals. This reform included compulsory, minimum nursing ratios (or nursing hours per patient per day) for most wards in the state’s acute hospitals.
It resulted in medical/surgical patients in Group A (Principal Referral) hospitals being entitled to, on average, six hours of nursing per day, Group B (Major Metro and Regional) hospitals 5.5 nursing hours per day and Group C (District) hospitals five nursing hours per day.
In terms of maternity/birthing facilities, the former government also agreed to adopt Birthrate Plus as the staffing model for Midwifery Services. Birthrate Plus is the generally accepted staffing ratio model for births per midwife in the UK and has been adapted for the NSW environment.
These improvements in nursing and midwifery hours, and the resultant ratios that were delivered, required the employment of an additional 1580 full-time-equivalent nurses and midwives over the last two years and delivered ratios that were close to the claims for one nurse to four patients made by the NSWNMA in 2010-11 for the Group A and Group B hospitals. Rehabilitation, palliative care and inpatient acute mental health wards also received nurse to patient ratios via improved mandatory nursing hours per patient.
The O’Farrell Government, which came to office shortly after the finalisation of this historic staffing agreement, has regularly praised and claimed credit for the employment of these extra nurses and midwives.
The 2013 claim
The 2013 ratios and wages claim, about to be considered by NSWNMA branches around the State, was compiled after extensive research into the views, experiences and priorities of NSWNMA members, research into the working conditions and staffing levels currently operating in hospital wards and community health facilities that do not yet have ratios and lengthy discussion within the NSWNMA’s log of claims committee, which contains rank-and-file members from most areas of nursing and midwifery.
The claim seeks a 2.5 percent annual payrise, without trade offs, in July 2013 and then another 2.5 percent rise, also without trade offs, in July 2014.
b) Extension of staffing ratios – see more local detail in attached table
Key features of this claim, with regard to nurse and midwife staffing, include:
NSWNMA general secretary, Brett Holmes, said the introduction of safer staffing arrangements in NSW hospitals and community health services was always going to be done over time.
“Nurses and midwives working under the first round of compulsory, minimum ratios are clear they have provided a safer clinical and less stressed working environment. The challenge for the O’Farrell Government is to build on this and ensure every public patient in NSW has access to the same level of safer care.
“After all, the O’Farrell Government is very willing to take credit every time a new batch of nurses or midwives is employed to fill the new positions created by the ratios, which were actually agreed between the NSWNMA and previous Labor government. It will be interesting to see how it reacts now that it has a chance to act in its own right and extend this reform into other important areas such as children’s wards and rural facilities.
“Many people would be surprised and shocked to know that minimum staffing levels are currently not guaranteed in NSW hospitals for seriously ill infants and children. No right-thinking person could think that state of affairs should continue.
“And what about emergency departments and other high pressure areas such as intensive care units? They also don’t have guaranteed minimum staffing levels at the moment. Things usually work okay, because hardworking and responsible clinicians ensure they do. But to continue leaving it to chance is not acceptable. Minimum safe staffing must be guaranteed and enforceable.
“It is also now time to guarantee safer staffing levels in the State’s smaller country hospitals and multipurpose services. I grew up in the country myself and have strong personal feelings, as well as professional views about this. Rural people, who do not have immediate access to the major hospitals and all the bells and whistles that go with them, are at least entitled to the same guaranteed nursing and midwifery ratios as the big Sydney hospitals. In fact, because these hospitals don’t have the same level of other resources as the larger hospitals, there is an even stronger case for them having guaranteed safer staffing resources to compensate.
“Finally, governments and health administrators are always going on about the importance of primary health care and doing more to keep people out of hospital and minimising unnecessary hospital admissions. Community health services, including community mental health services, are vital to achieving this goal. However, they can’t do it if nurses and midwives are stretched to the limit. That is why it is now also time to introduce stricter, enforceable staffing arrangements in community health services, which include a reasonable balance between face-to-face patient or client time and the time required for things like travel, research and administration.
“As for the pay rise claim, it will maintain the position of nursing and midwifery in relation to similar professions, as we prioritise this important staffing reform at this time. We now await the verdict of our members,” Mr Holmes said.
NSWNMA Ratios Claim in Detail
Newsrooms please note:To assist you with interpreting your local circumstances more detailed information, on the safer ratios being sought, is contained in this table. Please keep a copy of this information, as it will not be contained in all future press releases.
It shows the proposed minimum nursing hours per patient day to be claimed for different ward types. The equivalent ratio is also shown. Only nurses providing direct clinical care are included in the ratios/nursing hours. This does not include positions such as NUMs, NMs, CNEs, CNCs, dedicated administrative support staff and wardspersons
Specialty / Ward
Peer Group B (Major Metropolitan and Major Non-Metropolitan Hospitals)[i]
(includes some shifts staffed with an in charge)
Peer Group C (District Group Hospitals)1
Peer Group D (Community Acute and Community non-acute Hospitals)1
Peer Group F3 (Multi-Purpose Services – Acute Beds)1
Peer Group F3 (Multi-Purpose Services – Aged Care Beds (DoHA funded) )[ii]
Adult – in specialised Mental Health Facilities[iv]
Acute Mental Health Rehabilitation4
Child and Adolescent[v]
1:2 + in charge
10.5 + additional hours for in charge
Long Term Mental Health Rehabilitation5
1:6 + in charge
1:6 + in charge
3.67 + additional hours for in charge
Older Mental Health5
1:3 + in charge
7.33 + additional hours for in charge
Department (adult and paediatric)[vi]
Level 4-6 Emergency Departments
1:3 + in charge + triage
1:3 + in charge + 2 triage
8.67 + additional hours for in charge and triage
Level 3 Emergency Departments
Level 2 Emergency Departments
1:4 + in charge
7.83 + additional hours for in charge
6.5 + additional hours for in charge
General Inpatient Wards
+ in charge
8.67 + additional hours for in
intensive care units[viii]
+ in charge
26 + additional hours for in charge
+ in charge
13 + additional hours for in charge
Special Care Nurseries[ix]
8.67 + additional hours for in charge
(adult and paediatric)[x]
Community Health and Community Mental Health services,
except for Acute Assessment Teams
Limit of 4 hours of face-to-face client contact per
8-hour shift, averaged over a week.[xi]
Community Mental Health Services (Acute Assessment
Limit of 3.5 hours of face to face client contact per 8
hour shift, averaged over a week.11
[i] General Adult Inpatient Wards: This minimum-staffing claim applies to all Medical, Surgical and combined Medical/Surgical wards in Peer Group B (Major Metropolitan and Major Non – Metropolitan Hospitals), Peer Group C (District Group Hospitals), Peer Group D (Community Acute and Community Non – Acute) and Peer Group F3 (Multi Purpose Service – acute beds). The staffing ratio expressed as nursing hours provides the option of rostering some shifts with a nurse in charge who does not also have an allocated patient workload. This claim is the same as currently legally mandated ratios/nursing hours for Peer Group A city hospitals.
[ii] General Adult Inpatient Wards: This minimum-staffing claim will apply only to the DOHA-funded beds of Peer Group F3 Multi Purpose Services.
[iii] Inpatient Mental Health: This claim does not apply to adult acute mental health wards in general hospitals that are not ‘specialised’ mental health facilities, because these wards already have legally mandated nursing hours/ratios under the 2011 Award. This claim does not apply to forensic or PECC units.
[iv] Acute Adult Mental Health – Specialised Facilities and Acute Mental Health Rehabilitation: This minimum staffing claim provides the option of rostering some shifts with a nurse in charge who does not also have an allocated patient workload.
[v] Child and Adolescent, Long Term Mental Health Rehabilitation and Older Mental Health: In addition to this minimum staffing claim, additional hours must be provided for in charge of shift across two shifts.
[vi] Emergency Department (adult and paediatric): This minimum-staffing claim applies to adult and paediatric Emergency Depts according to their NSW Health designated level. This claim applies to beds, treatment spaces, rooms and any chairs where these spaces are regularly used to deliver care. The claim includes Emergency Depts, Emergency Medical Units, and Medical Assessment Units (whether co-located with an ED or not) and other such services however named. Additional hours must also be provided for in charge of shift and triage nurses across all shifts, where specified in the table above. The minimum nursing hours/ratios will not include Clinical Initiative Nurses or any other nurse however named whose role has been introduced for a specific purpose.
[vii] Paediatrics: This minimum-staffing claim applies to all paediatric general inpatient wards including medical, surgical and combined medical surgical wards and units across all Peer Groups. Additional hours must also be provided for in charge of shift across all shifts as specified in the table above. Further additional hours must be provided for nurse escorts and work that in general adult hospitals would be described as ‘ambulatory care’.
[viii] NICU: This minimum-staffing claim applies across all Peer Groups. Additional hours must also be provided for in charge of shift across all shifts as specified in the table above. Further additional hours must be provided for work that may be described as discharge nurse, neonatal family support and transport nurse (including retrieval).
[ix] Special Care Nurseries: This minimum-staffing claim applies across all Peer Groups. Additional hours must also be provided for in charge of shift across all shifts as specified in the table above. Further additional hours must be provided for work that may be described as discharge nurse, neonatal family support and transport nurse (including retrieval). The Special Care Nurseries claim does not apply to the following named special care nurseries that perform CPAP, where the HDU claim will apply instead: Blacktown, Campbelltown, Gosford, Lismore, St. George, Tweed Heads, Wollongong, Coffs Harbour, Dubbo and Wagga Wagga.
[x] Critical Care, including Adult and Paediatrics: This minimum staffing claim applies to Critical Care units, including Intensive Care Units, High Dependency Units and Coronary Care Units across all Peer Groups. Additional hours must also be provided for in charge of shift across all shifts. Further additional staffing (eg. access nurse) may be clinically required and if so, should be provided.
[xi] Community Health and Community Mental Health: Work that is not included in ‘face to face hours’ includes travel, meal breaks and administration (eg. phone calls to other health professionals or suppliers, paperwork), otherwise known as ‘indirect care’. ‘Face to face hours’ may also be known as ‘direct care’. [xi]
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