Sunday 16th July 2006
AHS restructure plans for nurse managers pose grave threats to the nursing profession.
Plans by the Area Health Services (AHS) to downgrade nurse managers pose the most serious threat to the nursing profession for the past 10 years, warns NSWNA Assistant General Secretary Judith Kiejda.
The Greater Southern Area Health Service (GSAHS) and Hunter New England Area Health Service (HNEAHS) have revealed plans to downgrade a large number of onsite nurse manager positions at rural facilities and install a general business manager across a cluster of health services.
The plans not only mean a downgraded role for these nurse managers but the AHSs are proposing these positions should include an additional clinical load – posing an impossible burden on these already overloaded roles.
Deputy DoN and NUM positions have also been deleted or downgraded at a number of facilities in the GSAHS restructure plan.
Devalued and overloaded nurse managers would be expected to struggle with their increased workload while suffering a wipe-out of these crucial nursing support positions.
The Northern Sydney Central Coast Area Health Service has also threatened to downgrade divisional nurse managers, eliminating operational and budgetary responsibilities from the role.
We won’t accept a downgraded role
The NSWNA has been engaged in intensive consultation with nurse managers regarding the proposed downgrade. ‘The feedback we are hearing from nurses managers is very grave indeed,’ said Judith.
‘The nursing profession is being seriously devalued by these plans.
It lowers the rank of nurses in the health system. Nurses will have a lower rank, less influence, less pay but heavier workloads if the AHSs have their way.
‘This will filter down to all levels of nursing and will have impact on patients and their local communities.
‘What is being proposed imposes an impossible and dangerous workload on nurse managers and this will flow through to all nurses and health staff.
‘If implemented, the plan would undermine the confidence of local communities in their local health service and exacerbate the already serious problem of retaining and attracting nurses to these rural services,’ said Judith.
‘These are frontline positions and they were never supposed to be targeted in the restructure.’
The NSWNA will be engaging in union-specific meetings with the AHSs over the coming months to demand a review of the roles and positions of the facility nurse managers.
At the time of going to press, the GSAHS and NSW Health have agreed to meetings with the NSWNA and nurse managers to discuss their grave concerns with the restructure proposal. The HNEAHS has also agreed to meetings with the Association and nurse managers.
Downgrade breaches Award
The proposal to downgrade nurse mana-gers and increase their clinical load and other responsibilities is in contravention of the nurse manager grading system in the Public Health System Nurses’ and Midwives (State) Award.
In many rural health facilities the Deputy Director of Nursing position has been deleted which, according to legal advice obtained by the NSWNA, is in clear breach of the Award. In some instances, AHSs have decided to ‘tidy up’ other structure nuances by deleting NUM positions without consultation with the NSWNA.
Any proposal to change the grade of these positions would need to be put to a Grading Committee, which would examine the roles and activity levels at facilities.
Fourth tier of AHS restructure
In 2004, NSW Health announced the amalgamation of the 17 AHSs at the time into eight larger AHSs.
Over the past 18 months, the NSWNA has successfully negotiated centrally with NSW Health to ensure a strong nurse presence in the first three tiers of the restructure. The facility nurse managers represent the fourth tier in the new AHS restructure.
‘We’ve had to fight hard but we have been successful so far in achieving appropriate nurse gradings in the upper tiers. Where we have had concerns with any roles, we have agreement with NSW Health to revisit the position in 12 months,’ said Judith.
The make up of the remaining structure is being determined at a local AHS level, not centrally through NSW Health.
When the restructure was announced, the then Minister for Health, Morris Iemma, stated the primary objective of the restructure was to be cost savings on the administration side that would be channelled into frontline staff and services.
NSWNA General Secretary Brett Holmes and Assistant General Secretary Judith Kiejda are demanding that the AHSs uphold this promise in regard to the remaining tiers.
‘We will continue the fight. We are determined to protect our nurse managers and ensure these senior positions are underpinned by strong nursing support positions,’ said Judith.
There was also the promise of a sound consultation process that would involve the AHSs talking to unions including the NSWNA, clinical staff and communities.
‘The AHSs have failed in this promise,’ said Judith.
Plans for a weaker nurse manager
The restructure plans by GSAHS and HNEAHS include the installation of a general business manager with responsibility for the administrative functions of a cluster of three to four health services within the AHS.
The business manager is located at one facility, yet may have responsibility for a number of (in one case 11) facilities that can be hundreds of kilometres or several hours away.
At each facility is an onsite nurse manager or health service manager, who is responsible for all the general management of the facility including all human resource issues and service needs of the facility as well as having the skills, knowledge and expertise to coordinate a response to a major trauma.
The GSAHS and HNEAHS are arguing the nurse manager positions should be downgraded because they have a reduced administrative role with the installation of the business manager.
‘In theory, the business manager should be taking on much of the administrative load but that’s not the reality. A general manager several hours’ way is not going to be stepping in to fix the hot water or manage disputes between staff, for example. It’s just not practicable,’ said Judith.
‘It’s the onsite nurse manager who actually looks after the day-to-day functioning of the service and has to undertake all the preparatory work required by the general manager.’
The NSWNA Nurse Managers’ Branch in the GSAHS reports that the business managers have increased their workload, rather than reducing it.
For example, the onsite nurse managers are being bombarded by requests for backup documentation supporting the use of overtime, submissions for various reviews and reports about patient waiting lists.
‘There is the expectation that the nurse managers must drop everything and respond immediately to these requests – even if they are caught up ad-dressing clinical issues,’ said Judith.
Additional clinical duties for nurse managers already under pressure
The nurse manager positions tabled by GSAHS and HNEAHS include a significant clinical load. The GSAHS expects its nurse managers to be undertaking clinical duties two days’ per week, and the HNEAHS one day per week.
This is on top of their current administrative load; this is with less support due to the deletion or downgrading of the Deputy DoN and NUM positions at most facilities.
The NSWNA has not been provided with any supporting data or information to justify the reductions in the management time in the role and members have not been consulted about this change.
‘The proposal is ridiculous and shows a total lack of understanding by AHS management of the role of a nurse manager,’ said Judith.‘On any day, an onsite nurse manager is responsible for finding nurses for the next shift, steps in to address disputes between staff members, organises for equipment to be fixed as well as coordinating clinical activities.
‘If we have the nurse manager caught up with clinical duties two days’ per week, who’s going to step in to organise a response to a clinical emergency and find staff for the next shift?’ said Judith.