NSW nurses prepare to defend patient safety after Vic. nurses victory

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"This is a bittersweet victory for nurses and midwives after an unprecedented industrial marathon with the Baillieu Government to protect patient care and secure a fair pay rise.” — Lisa Fitzpatrick, State Secretary, Australian Nursing Federation (Victoria).

The Australian Nursing Federation (ANF) of Victoria has had a good win. At a time when the employers are on the march, the Victorian ANF ran a campaign that involved two periods of industrial action, including bed closures, elective surgery cancellations and four hour rolling stoppages twice a day.

The ANF held community rallies, doorknocked electorates and threatened mass resignations from health services. For their efforts, the employers threatened nurses at one stage with a wharf-style lockout. But once it was pointed out to the employers and the Victorian government that they would be held liable for any adverse events that occurred in the health system as a result of that lockout, the idea was quickly dropped.

At a mass meeting at Melbourne’s Festival Hall on March 16, nurses in the Victorian ANF voted to accept a new agreement. The agreement was reached at midnight the day before through negotiations at Fair Work Australia.

The four-year agreement will expire on March 31, 2016.

For their dogged determination over nine months, Victorian nurses have been rewarded with what appears to be a good outcome, at least for now.

The details of the agreement between the Victorian health service employers and the Victorian ANF are yet to be spelled out (and the devil is usually in the detail). But the ANF has announced that there will be a single agreement covering all public hospital nurses, midwives, public aged care nurses and nurses employed in Victoria’s stand alone community health centres.

Finally, there is an end to all those individual agreements imposed on the industrial system in Victoria, in particular during the years of the John Howard government’s Work Choices.

There will be pay rises of between 14% and 20% for all nurses. Night duty penalty rates have been simplified into a single rate. Four hour shifts and split shifts will not be introduced. Nurses in Victoria will be paid an allowance to assist with recent changes to their re-registration requirements.

Most importantly, Victorian nurses retain, and in some circumstances improve, nurse-to-patient ratios.

They retain registered nurses in registered nurse positions and the allowable number of enrolled nurses in medical surgical wards rises to 20% from 15%. There will also be a new career structure for enrolled nurses.

Registered nurses will not be replaced with health assistants, a very important win for the ANF in its fight to maintain standards of safe patient care in Victorian health services.

Retaining the ratios is also important for nurses in other states of Australia. The abolition of the ratios in Victoria would have eroded the ratios that exist in NSW and delivered a fatal blow to ratios being the staffing system in the other states.

There are some productivity offsets which include the provisions that employers can staff below the ratios in very limited circumstances based on consideration of the consequences of strict criteria including “patient acuity, nurses’ satisfaction and nursing sensitive outcomes such as falls, urinary tract infections, pneumonia, decubitus ulcers, thrombosis, sepsis and medication errors”.

Meanwhile, in NSW, the relationship between the NSW Nurses Association and the Barry O’Farrell coalition government is souring. A recent interim report by the NSW Commission of Audit sets out a program of wide ranging reform for the NSW public sector.

This report has significant implications for the NSW public sector, for patient safety and for nurses' conditions at work.

Among other changes, the report recommends: "NSW Public Sector Wages Policy be amended to include a provision that workforce management policies (such as staff ratios) should not be included in industrial agreements."

The Nurses Association said the report specifically refers to:
• nursing hours per patient bed day, or nurse-to-patient ratios
• teacher-to-pupil ratios
• police authorised strength
• resource models for ambulance officer numbers
• firefighter crew per appliance.

NSW nurses waged a campaign in NSW in 2010 that won nurses new staffing arrangements based on nursing hours per patient day. In its initial approach to the government at the time, NSW nurses sought similar ratios to those in Victoria.

With the nursing hours per patient day formula, nurses in NSW achieved a mathematical means of getting better nurse-to-patient ratios. The difference in NSW is that those ratios could also include lower-skilled assistants in nursing.

Anecdotal evidence also shows that implementation of the ratios in NSW hospitals still depended on management budget decisions. If NSW nurses were told there was no budget to implement the ratio in a particular ward, it didn’t happen.

Nevertheless, through ongoing negotiations, areas such as the Northern Sydney Local Health Network were to employ an extra 116 nurses by June 2013. If the state government moves to have the clauses that refer to staffing arrangements in Nurses Awards amended in line with its stated intention in the Interim Report, those extra nurses will not be employed and staffing arrangements will be decided according to management budget decisions.

The Nurses Association has anticipated something like this from the O’Farrell government ever since it was elected. Now, the government is making the first moves.

The Nurses Association is engaging in a process of informing its members of the government’s intentions and asking members to approach their local MP. When I approached my MP, I was met with a blanket denial that there was any intention to change the existing Memorandum of Agreement between the government and the Nurses Association. But I was told “future salary increases for nurses will be in-line with the government’s wages policy”.

The O’Farrell government passed legislation last year that capped public sector wage rises at 2.5% a year. Those laws also rendered the NSW Industrial Commission powerless as an independent umpire in nurses wages outcomes.

In addition, the NSW government has introduced a second wave of laws into parliament that introduces fines of $110,000 for public sector unions that take strike action.

This means that should nurses be forced to stop work, close beds or reduce services to win safe patient care as they did in November 2010, and January last year, the Nurses Association could be fined $110,000 a day.

All of this is shaping up for an ugly confrontation between the O’Farrell government and the Nurses Association. It is a wonder that the O’Farrell government is not looking over its shoulder at the determination of Victorian nurses and the new agreement that has been reached in Victoria. That agreement should be a benchmark for NSW.

NSW nurses, with the right leadership, could wage just as determined a campaign as the Victorian nurses did. After all, in the end it is all about safe patient care, professional standards of care by well-educated nurses, patient satisfaction and job satisfaction for nurses.

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