- 1 of 8 - NSW NURSES & MIDWIVES ASSOCIATION General Secretary: Brett Holmes Assistant Secretary: Judith Kiejda Ph: 02-8595 1234 PRESS RELEASE ATTENTION: Hunter New England media outlets 11 February 2013 Hunter New England nurses challenge O Farrell on safer hospital staffing 1. Hunter New England nurses and midwives to start voting on staff ratios and wages claim next week 2. NSW still doesn t guarantee safe nursing levels for seriously ill children, emergency departments or rural hospitals NSW Nurses and Midwives Association (NSWNMA) branches at public hospitals and community healthcare centres in the Hunter New England Local Health District will start voting next week on a proposed staff ratios and wages claim, which challenges the O Farrell Government to build on the safer hospital staffing levels first introduced in 2011 under an agreement between the NSWNMA and previous Labor government. 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 per cent 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. Fifty NSWNMA branches, representing more than 4100 public-sector nurses and midwives in the Hunter New England District, are eligible to vote. Voting starts next Monday, 18 February, and finishes two weeks later, at 4.00pm Friday, 1 March. Claim information and branch voting kits were sent to Hunter New England LHD branch officials this afternoon, 11 February. Hunter New England NSWNMA branches Facility classification Armidale Community Health Centre Armidale Rural Referral Hospital C1 District Group 1 Barraba Multi Purpose Service Boggabri Multi Purpose Service 1
- 2 of 8 - Cessnock Community Health Centre Cessnock Correctional Centre F8 Ungrouped Non-Acute Child Adolescent & Family Health Service Dungog Community Hospital D2 Community Non-Acute East Maitland Community Health Centre Forster Community Health Centre Glen Innes Correctional Centre F8 Ungrouped Non-Acute Gloucester Soldiers Memorial Hospital The D1a Community Acute With Surgery Gunnedah Community Health Centre Gunnedah District Hospital C2 District Group 2 Guyra Multi Purpose Service Hunter New England Community HS - Hunter Region Hunter New England Mental Health Unit (Waratah) F1 Psychiatric Inverell District Hospital The C2 District Group 2 John Hunter Children's Hospital John Hunter Hospital A1 Principal Referral Kaleidoscope Services Kurri Kurri District Hospital C2 District Group 2 Lower Hunter Community Health Lower North Coast Community Health Maitland Hospital BNM (Major Non-Metropolitan) Maitland Psychiatric Unit Manilla Health Service D2 Community Non-Acute Manning Hospital - Taree BNM (Major Non-Metropolitan) Merriwa Multi Purpose Service Moree District Hospital C2 District Group 2 Morisset Hospital F1 Psychiatric Muswellbrook District Hospital C2 District Group 2 Narrabri District Hospital & Health Service C2 District Group 2 Newcastle Community Mental Health Service Nexus Child and Adolescent Mental Health Unit Quirindi Community Hospital D1b Community Acute Without Surgery Rankin Park Unit F6 Rehabilitation Royal Newcastle Centre Scott Memorial Hospital - Scone D1a Community Acute With Surgery Singleton District Hospital C2 District Group 2 St Heliers Correctional Centre F8 Ungrouped Non-Acute Tamworth Community Health Centre Tamworth Correctional Centre F8 Ungrouped Non-Acute Tamworth Rural Referral Hospital BNM (Major Non-Metropolitan) Taree Community Health Centre Tenterfield Community Hospital D1b Community Acute Without Surgery Tomaree Community Hospital Wallsend Community Health Centre - West Newcastle Warialda Multi Purpose Service Werris Creek Community Hospital D2 Community Non-Acute If approved by a majority of the Statewide 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. The first television advertising in support of the claim is already underway around the State. 2
- 3 of 8 - Historical background 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. a) Pay The claim seeks a 2.5 per cent annual payrise, without trade offs, in July 2013 and then another 2.5 per cent rise, also without trade offs, in July 2014. b) Extension of staffing ratios Key features of this claim, with regard to nurse and midwife staffing, include: applying compulsory minimum ratios in all hospitals, including smaller rural hospitals and multipurpose services (MPSs), to the same level as Group A (principal referral) hospitals such as Westmead, Royal North Shore and Wollongong hospitals; introducing compulsory minimum ratios to children s hospitals, wards, neo-natal intensive care units and paediatric critical care units; introducing ratios to emergency departments, medical assessment units, emergency medical units and adult critical care units; 3
- 4 of 8 - introducing mandated face-to-face patient/client time in community nursing; and extending ratios to more mental health units and improving ratios in mental health hospitals. (Newsrooms please note: To assist you with interpreting your local circumstances more detailed information, on the safer ratios being sought, can be found in the attached table.) Comment 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. 4
- 5 of 8 - Media inquiries: Brett Holmes 02-8595 1234; 0414-550 324 Judith Kiejda 0414-674 119 Lisa Kremmer 0414-550 361 John Moran (for media assistance only) 07-3366 9010; 0410-603 278 NSWNMA ratios claim in detail The table 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 Type Equivalent Ratios AM PM Night General Adult Inpatient Wards Peer Group B (Major Metropolitan and Major Non-Metropolitan Hospitals) i 1:4 1:4 1:7 Nursing Hours 6 (includes some shifts staffed with an in charge) Peer Group C (District Group Hospitals) 1 1:4 1:4 1:7 Peer Group D (Community Acute and Community non-acute Hospitals) 1 1:4 1:4 1:7 Peer Group F3 (Multi-Purpose Services Acute Beds) 1 1:4 1:4 1:7 Peer Group F3 (Multi-Purpose Services Aged Care Beds (DoHA funded) ) ii 1:6 1:6 1:7 4.1 Inpatient Mental Health iii Adult in specialised Mental Health Facilities iv 1:4 1:4 1:7 Acute Mental Health Rehabilitation 4 1:4 1:4 1:7 Child and Adolescent v 1:2 + in charge 1:2 + in charge 1:4 Long Term Mental Health Rehabilitation 5 1:6 + in charge 1:6 + in charge 1:10 Older Mental Health 5 1:3 + in charge 1:3 + in charge 1:5 6 (includes some shifts staffed with an in charge) 10.5 + additional 3.67 + additional 7.33 + additional Emergency Department (adult and paediatric) vi Resuscitation Beds 1:1 1:1 1:1 26 5
- 6 of 8 - Equivalent Ratios Nursing Specialty / Ward Type AM PM Night Hours 1:3 + in charge 1:3 + in charge 1:3 + in charge Level 4-6 Emergency Departments + triage + 2 triage + triage 8.67 + additional 1:3 + in charge 1:3 + in charge Level 3 Emergency Departments 1:3 + in charge and triage + triage + triage Level 2 Emergency Departments 1:3 1:3 1:3 8.67 EMUs 1:3 + in charge 1:3 + in charge 1:4 + in charge MAUs 1:4 + in charge 1:4 + in charge 1:4 + in charge 7.83 + additional 6.5 + additional Paediatrics vii General Inpatient Wards 1:3 + in charge 1:3 + in charge 1:3 + in charge Neonatal intensive care units viii ICU 1:1 + in charge 1:1 + in charge 1:1 + in charge HDU 1:2 + in charge 1:2 + in charge 1:2 + in charge Special Care Nurseries ix 1:3 + in charge 1:3 + in charge 1:3 + in charge Critical Care (adult and paediatric) x ICU 1:1 + in charge 1:1 + in charge 1:1 + in charge HDU 1:2 + in charge 1:2 + in charge 1:2 + in charge CCU 1:3 + in charge 1:3 + in charge 1:3 + in charge 8.67 + additional 26 + additional 13 + additional 8.67 + additional 26 + additional 13 + additional 8.67 + additional Community Health and Community Mental Health services, except for Acute Assessment Teams Community Mental Health Services (Acute Assessment Teams) Limit of 4 hours of face to face client contact per 8 hour shift, averaged over a week. xi 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 6
- 7 of 8 - 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 Departments 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 Departments, 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 7
- 8 of 8 - professionals or suppliers, paperwork), otherwise known as indirect care. Face to face hours may also be known as direct care. 8