Sunday, November 13, 2011



I hear the government and employers are backing away from a lockout of Victorian nurses because they have received legal advice that they would be liable for any adverse events during a lockout. But this is going to be a tough dispute and should be followed closely. Hopefully the health unions nationally are ready for this. The loss of the ratios in Victoria would set a benchmark for nurses nationally. We should be prepared to defend the ratios in Victoria by national action.

Jenny Haines

The Age

Kate Hagan, 12.11.11

ON THE job over the past couple of days, thousands of Victorian nurses have worn T-shirts emblazoned with the words ''respect our work''. It is the bottom line for many in their latest round of negotiations with the government over the enterprise agreement that governs their pay and conditions.

About 30,000 nurses are seeking an 18.5 per cent pay rise over the next three years and eight months. The Baillieu government is offering them 2.5 per cent. Any further pay rise, the government has said, will need to be offset by productivity gains.

Victoria's nurses are among the lowest paid in the country. But what they do have on their side are mandated nurse-patient ratios that ensure minimum staffing levels for different categories of patients. For a general surgical ward at a major metropolitan hospital, one nurse is rostered for every four patients during the day and one for every eight at night. Fewer nurses are rostered on for the same ward in a country hospital. And there are variations between wards - more nurses are needed for intensive care patients, and fewer for those undergoing rehabilitation after a spinal or brain injury.

Advertisement: Story continues below Nurses like ratios because they give some protection against overwhelming workloads. Several NSW nurses quit Albury hospital to work for less at Wodonga after Victoria introduced them in 2000 following a landmark decision in the Australian Industrial Relations Commission.

Other states have since adopted models that provide a minimum level of nursing care for patients, depending on their needs. But the government says those models are more flexible - and that only in Victoria are there fixed ratios that must be applied every minute of every day regardless of how busy a ward is, or how sick its patients.

A spokeswoman for Health Minister David Davis says the government supports ratios but wants ''local flexibility for staff allocations that provide more nurses at the busiest times and fewer nurses during quieter times''.

The state secretary of the Australian Nursing Federation, Lisa Fitzpatrick, counters that there is already ''extraordinary flexibility'' in ratios, and that nurses are busier than ever. She says ratios are the reason that Victoria, unlike other states, does not have a nursing shortage. In other states, shortages have been used to make a case for lesser-trained health assistants. Both measures - more flexible ratios and the introduction of health assistants - are at the heart of ''productivity improvements'' proposed by the state government as part of its EBA negotiations with nurses. A leaked cabinet document this week revealed that the proposals, which are opposed by nurses, could save $104 million.

Austin Hospital chief executive Brendan Murphy argues that employing health assistants to perform personal care tasks such as feeding and bathing patients is common sense. His hospital has recently completed a two-year trial in which 30 health assistants were employed to work on acute wards, under the supervision of registered nurses. He says the feedback from nurses and patients has been overwhelmingly positive, and that assistants have been employed at the hospital permanently. ''What we're trying to do is supplement the nursing workforce where appropriate and use people to the best of their skills. We shouldn't be wasting our incredibly precious and well-trained nurses doing basic tasks.''

The model has been evaluated by consultants, in a report being considered by the government. That rings alarm bells for Fitzpatrick, who is adamant that health assistants - who have about 80 hours' clinical experience compared with the 1000 hours of a registered nurse - have no place on an acute ward. She recalls one nurse telling her about a health assistant who was having difficulty understanding that a patient listed as ''not for resuscitation'' wanted only pain relief and to die in peace. ''Many nurses would deal with that every day of their working life. But this health assistant couldn't accept that … The nurse had to spend three hours with her over the next few shifts trying to talk her through it.''

Fitzpatrick says ratios providing for a minimum number of registered nurses are vital for safeguarding patient care. She says hospital chief executives hate ratios because they lock up a portion of their budgets. ''Our [staffing] budget can't get hived off to pay for a new MRI [machine].''

A decade ago, ratios were crucial in bringing nurses back to Victoria's public health system after thousands of them were made redundant under the Kennett government. Now they have got ratios, nurses are determined to hold on to them. With patients becoming sicker as the population ages - perhaps with diabetes or a chronic lung disease in addition to the fractured hip that has brought them to hospital - nurses are pushing for the ratios to be improved. But every three years when their enterprise agreement comes up for renegotiation, they find themselves fighting simply to maintain the status quo.

Neurosurgical nurse Rachael Duncan tells, in Suzanne Gordon's book Nursing against the Odds, of routinely caring for 10 patients - four of them in a high-dependency area - at the Austin Hospital before ratios were introduced.

''You left work feeling like a wet rag. There was a very poor skill mix on the floor. A lot of casual nurses were making up the numbers. Nursing is always hard work, but you never got ahead, you were always chasing everything. You never felt like you'd done your job [and] everyone was stressed,'' she said.

Returning to work after maternity leave, following the introduction of ratios, Duncan said she would leave for the day feeling she had done her job well. In one instance she had to drop everything to stabilise a patient who had developed a life-threatening blood clot in the lung and rush him to intensive care. She returned two hours later to find her colleagues had given her other patients their medications, taken their vital signs and changed their dressings - something she says never happened before ratios.

Louise Gates, 26, did not work in the hospital system before ratios - but even with them, she found the workload high, the responsibility immense. After three years at university to qualify as a division one nurse, she left the profession after just 18 months. She says many of her friends did the same.

''For me, there wasn't enough incentive to stay in nursing. I didn't feel valued enough, and I didn't think the remuneration was adequate for the responsibilities nurses have,'' she says. ''You get home from a shift absolutely exhausted, and then you're on the very next morning, waking up at 5am.''

That said, there was much in the job that she enjoyed. ''There's great parts about nursing: you form such great friendships and have a sense of purpose. I definitely miss the daily interaction with patients, and the medical side of things.''

Not everyone is convinced that ratios are the answer. Monash University researcher Virginia Plummer, while agreeing that they have restored control to nurses and brought them back into the Victorian system, says that as patient care becomes more complex, a far more sophisticated approach is needed. She believes that computer systems that crunch data on peaks and troughs in clinical workloads (based on patient numbers and complexity), and roster nurses across a hospital accordingly, can save money, improve patient care and result in fairer workloads. But, for now, she says, in Victoria, ratios are ''absolutely entrenched''.

Plummer says Victoria was in ''dire straits'' in 2000 when nurses left the system in droves because they could not bear to see the quality of nursing deteriorate. The introduction of mandated ratios was so successful, she says, that nurses will reject anything that threatens that system. ''It made them come back… and it made them trust their workplace. We hope that in time other systems will be accepted. But it's not the right time. The memories are still there.''

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