NSW nurses have voted to accept the state government’s wages, conditions and ratios package. Anecdotal reports indicate that 90% of the branches voted in favour of the package, but the head office of the NSW Nurses Association (NSWNA) has not released official figures.
There was some reluctance among nurses to vote for the package, as it did not include mandatory nurse to patient ratios. Nurses have been calling for one nurse to every four patients. The campaign run by the Association promised ratios, but leading officers of the NSWNA knew and discussed unofficially that ratios were unachievable.
The package was presented by the leadership of the NSWNA and The Lamp, the NSWNA’s monthly magazine, as a great achievement, and the best that could be achieved under a Labor government. Members were left in fear of an incoming Liberal government.
Nurses have accepted a 9.7% wage rise over the next four years. Inflation over that period is expected to be 10.5%. Ambulance officers received a 15.7% wage rise just before Christmas 2010 to cover the same period.
Fourteen hundred “new” nursing staff are to be employed to meet the need for more staff. But it is unclear where these new staff will come from.
No doubt some will be recent graduates from the past couple of years who were unable to get positions in the public health system at the time of their graduation and who have since been working casually, through an agency or doing aged care.
They will need educational support when they start work in acute wards, but the package does not include a plan to employ any more clinical nurse educators.
All clinical education is to be carried out by existing educators, ward based preceptors and mentors, thereby increasing the workload of these ward and unit staff.
It is also very difficult and expensive for staff seeking to enter or re-enter the workforce.
There is only a limited range of very expensive courses for them to update their knowledge and skills prior to employment. For example, the Assessment of Competence Course at the College of Nursing costs $10,000, which must be paid prior to the start of the program.
Rather than ratios, the package provides for improved staffing levels, based on a nursing hours per patient day (NHpPD) calculation. The staffing increases are much needed in the wards for which they have been achieved.
But there is no guarantee that a staffing system based on the NHpPD model will address skill mix problems. Nothing in the package prevents hospitals and health services employing more nursing assistants rather than fully qualified nurses to fill these hours.
This provides a stronger argument for educational support for those wards on a 24 hours a day, seven days a week, 365 days a year basis.
Under the agreement, understaffing must be pursued as a breach of the award through the disputes process. This can prove long and difficult.
There are to be “spot checks” of staffing levels, but it remains unclear how this process will work or whether the union will have any input.
In 2003, when Reasonable Workloads provisions were inserted into the award for registered nurses and enrolled nurses, the promise was made that midwives would get their own staffing system, Birth Rate Plus. Seven years later that system has still not been implemented.
The 2011 package promises that the Birth Rate Plus system will be implemented soon, but NSW midwives have every reason to be wary of the promises made.
The outcome with regards to staffing levels for community health and mental health is also disappointing. Community nurses have been promised a better system of monitoring staffing levels, but again how this will be implemented is not clear.
In mental health the NHpPD system will apply in acute wards only.
The staffing arrangements provided for in the package make it the responsibility of the Nursing Unit Manager (NUM) to ensure that the correct number of nursing hours are provided on each shift.
This gives the NUM a lot of responsibility, but not much power to solve staffing problems. The decision to employ new staff and the total numbers employed is a decision made by senior management.
Leading officers of the NSWNA told members that this package was the best they could get from the Labor government and that members could not expect any sympathy from an incoming Liberal government.
If the NSWNA wants to know what position an incoming Liberal government would take on a claim for NSW nurses' wages, conditions and ratios, why didn’t they ask them, and then convey that response to the members?
Members have voted. It is likely that the NSW Industrial Relations Commission will implement the new award as confirmed by the membership vote.
This means there will be no extra claims during the life of the award and members are now limited to what has been achieved here for the next four years.
[Jenny Haines is a member of the NSW Nurses Association.]