Demands for ratios and fair pay underpin strike

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Striking nurses urge state to follow Victoria’s lead

Nurses and midwives from hospitals across New South Wales put down their tools and took to streets in cities and out the front of hospitals on September 1, striking for better working conditions and a pay increase to offset the rising cost of living.

By Harry Mulholland

The New South Wales Nurses and Midwives’ Association (NSWNMA) has urged the NSW Government to follow Victoria’s lead and future-proof the state’s health system by urgently investing in the nursing and midwifery workforce.

In welcoming the Andrews Government’s plan to recruit and train 17,000 nurses and midwives and cover the university fees of more than 10,000 nursing or midwifery undergraduate courses, the NSWNMA warns NSW is at risk of being left behind.

NSWNMA General Secretary, Shaye Candish, said it was imperative the NSW Government acknowledges the current staffing issues impacting the state’s public hospitals and act before it is too late.

“The Victorian government’s announcement is exactly the type of forward-thinking we have been championing in NSW to address some of the workforce concerns we can already see coming down the line here,” Candish said.

“In recent years we’ve seen 3,000 nurses and midwives move interstate, because they can experience better working conditions with mandated safe nurse-to-patient ratios in Victoria, Queensland, the ACT and soon to be in South Australia.

“Nurses and midwives want to show up for their shifts knowing there are enough suitably skilled other nurses and midwives to work alongside them and deliver the safest, best possible care to every patient.

“We know there are plenty of nurses and midwives pulling out of university studies or worse, walking away from a career in nursing or midwifery because they’ve had a negative experience during clinical placement in NSW,” Candish said.

Shining a light on the problem

In the lead up to the strike, nurses have been posting their testimonies on The Lamp, sharing their dissatisfaction with the state government’s inaction.

One aged care nursing student anonymously shared her story of her first shift, explaining that she was left on her own during an incident.

“My first shift as an aged care worker as an 18-year-old nursing student involved stopping a dementia resident from strangling another resident.

“I was alone.

“There were two other carers who were both dealing with other patients.

“I didn’t know what to do.

“The lack of training and staffing meant that I was alone with no help.

“I stood there holding the resident’s hands while no one came to help.

“The resident started to become aggressive with me.

“It is unacceptable… the lack of rations for the dementia floor is disgusting.

“If I was not there or helping another resident, what would’ve happened?

“Now a few weeks later, I have seen understaffed, burnt out and underpaid nurses, which is forcing me to reconsider if this is the future I want for myself.

“We need higher nurse-to-patient ratios, we need better pay, and we need more nurses.

“Something has to change, otherwise people will keep dying and nurses will keep leaving,” the nursing student said.

Another nurse working in a regional hospital in perioperative care shared her story of just how extreme the workload has become.

“I work in a regional centre in periop (surgery nurse).

“It’s common once a roster that we will do seven shifts in a row, the first three of those shifts are on call.

“With access to GPs now more difficult than ever and access to surgery also severely impacted, our emergency lists are overflowing, and the acuity and complexity of our patients has increased as well.

“This last lot of seven I’d already done over 40 hours between Friday and Sunday, dealt with a particularly traumatic arrest and had multiple ICU transfers.

“At the end of the seven days I’d completed just shy of 70 hours, whereas 12 months ago we’d be lucky to do five hours of overtime over those three days.

“It’s a level of fatigue I’m not comfortable with, but we don’t have the staff or the ability to cover sick leave which means lists get cancelled, and more work piles up.

“Calling off (sick) just perpetuates the cycle further.

“I don’t know how anyone can say our health system is coping with the level of impacts on patients and staff so high,” the perioperative nurse said.

Support for strike

A majority vote of the NSWNMA public sector members show 94 per cent of members were in favour of the strike which commenced at 7am on September 1 and finished the following morning.

Candish said nurses and midwives could no longer put up with dangerous staffing levels and unsustainable workloads.

“Our members are angry, and they’re fed up with being ignored.

“We indicated to the NSW government earlier this year that we needed an open and meaningful dialogue with them about safe staffing.

“We still don’t have mandated nurse-to-patient ratios in our public hospitals or health facilities and this is putting patients at risk.

“The NSW government is ignoring what’s desperately needed to ensure patients are getting the best possible care in their local hospitals.

“Our members are frustrated more than anything else because their concerns for patient safety have not been heard, and their professional perspectives and pleas for short and longer-term safe staffing solutions are not being acknowledged.

“Nurses and midwives are in a constant state of worry about their patients, about what they can’t do for their patients because they can’t be everywhere at once.

“This is not sustainable.

“Clinical health professionals should not be in a situation which means that every shift they go to work, they have to decide which patient gets care, which patient waits, and which patients misses out,” Candish said.

NSWNMA Assistant General Secretary, Michael Whaites, said more support was desperately needed on the ground and reiterated calls for more Clinical Nurse/Midwife Educators to be employed throughout the state.

“We have an ongoing nursing and midwifery retention problem in NSW because it’s more convenient for our decision makers to ignore these systemic issues.

“We’re continuing to urge the NSW and federal governments to work with us on developing practical, longer-term solutions to address these issues and ensure we can retain nurses and midwives across our state, but also provide a supportive and collaborative work environment for new graduates through to senior practicing clinicians,” Whaites said.

Whaites said both metropolitan and regional nurses and midwives were seriously overworked and the moral injury being reported was palpable, given the rising anger towards a system that’s preventing proper patient care.

“This widespread staffing crisis in our health system won’t simply go away as COVID-19 cases numbers slowly start to decline.

“What our members are asking for is not unreasonable. They are simply asking for staffing ratios, a safer workplace and fair pay.

“There is growing evidence nurse-to-patient ratios do save lives and result in better patient outcomes, and legislated ratios have already saved the Queensland Government millions of dollars.

“We are supporting our members in taking this action to demand the NSW government listen to our calls for safe staffing ratios.

“If the NSW government won’t take action, nurses and midwives will,” Thwaites said.

Victoria moves

On August 28, the Andrews Labor Government decided to back Victoria’s healthcare system with free university and specialist training for thousands of nurses and midwives.

The Victorian Government announced a $270M boost to their healthcare system, claiming they will recruit and train more than 17,000 nurses and midwives as part of a massive hiring and upskilling initiative.

As part of the investment, more than 10,000 university students will have the cost of their nursing or midwifery undergraduates, while scholarships are being made available to thousands more to help complete a postgraduate degree in the fields of intensive care, cancer care, paediatrics and nurse practitioner specialties.

All new domestic students enrolling in a professional-entry nursing or midwifery course in 2023 and 2024 will receive a scholarship of up to $16,500 to cover their course fees.

Students will receive $9,000 of this scholarship while they study, and the remaining $7,500 if they work in the Victorian public health service for two years.

The Victorian government has claimed more midwives will join the workforce through an expanded postgraduate midwifery incentive program which will cover course fees and salary support for 150 existing nurses to continue working whist they study.

This initiative, paired with the $12B Pandemic Repair Plan, brings the number of nurses and midwives being supported to more than 20,000 including funding for 13,000 nursing and midwifery positions and scholarships, and funding the upskilling of 8,500 nurses.

The Pandemic Repair Plan includes scholarships worth $11,000 for enrolled nurses to become registered nurses, $12,000 to train and employ 100 new nurse practitioners, and $20M to provide new nurses with access to clinical educators and preceptors.

Victorian Premier, Daniel Andrews, said he encouraged school leavers considering a career in nursing to join the profession.

“If you’re in Year 12 and you’ve been thinking about studying nursing or midwifery, go for it.

“We’ve got your HECS fees covered.

“Every health system in the country is under enormous pressure due to the pandemic.

“The best thing we can do to support our hardworking staff is to give them more support on the ground, that’s why this package will train and hire more nurses than ever before,” Andrews said.

Victorian Minister for Health, Mary-Anne Thomas, said the plan was beneficial for healthcare staff and patients.

“You can’t deliver a health system with empty hospitals, which is why we are investing in hardworking nurses and midwives that are helping Victorian patients every single day,” Thomas said.

Victorian Minister for Training, Skills and Higher Education, Gayle Tierney, said the plan was supporting healthcare staff in the areas they need it most.

“By providing more pathways and incentives to education, we’re giving our nurses and midwives the practical support that they need to continue caring for Victorians,” Tierney said.

Demand for ratios

This is the kind of support the NSWNMA wishes to see from the NSW government.

Their research collated from feedback from nurses across NSW shows a need for a transparent shift-by-shift ratio system with an appropriate skill mix and staffing levels based on the number of patients in each ward, unit or service.

In addition to this, the NSWNMA wants staffing for in-charge of shift nurses to not be allocated a patient load, AINs and AIMs rostered to work in an identified unit or ward with no allocated patient load, the most recent ACORN standards to apply to intensive and critical care units, and an appropriate skill mix where the most senior nurse on shift is in charge, among many others.

The NSWNMA are also seeking a seven per cent pay increase for all public sector nurses.

States join forces

The Victorian and NSW government in a bid to reduce the strain on emergency departments, announced a partnership to expand urgent care services.

Under this plan, Victoria and NSW will each establish 25 urgent care services in partnership with GPs to give patients faster care for urgent non-critical conditions and free up critical resources for patients with more serious needs.

The GP partnered services will be equipped to handle conditions such as mild infections, fractures and burns. These services will operate for extended hours, and patients will not be charged for the services provided by GPs.

Patients without a Medicare card will also be able to access these services at no cost.

These new services will be commissioned in partnership with Primary Health Networks, with their location being determined by considering population, community needs and emergency department demand.

In Victoria 10 centres will be established at Frankston Hospital, Bendigo Hospital, Casey Hospital, Albury Wodonga Health, Austin Hospital, Alfred Hospital, Dandenong Hospital, Latrobe Regional Hospital, Werribee Mercy Hospital and Box Hill Hospital.

Another 10 Victorian locations will be announced in the future.

In NSW, GPs and Primary Health Networks in Western Sydney, the Murrumbidgee, Northern Sydney and Western region have recently established partnerships, aiming to reduce the number of people presenting to emergency.

According to the NSW government, emergency departments in NSW collectively see more than three million patient presentations per year, and in the first quarter of 2022, 734,704 people attended an emergency department.

The NSW government claims to have implemented a range of initiatives to improve healthcare outcomes including a secondary triage program in partnership with residential aged care facilities and NSW Ambulance, an expansion of virtual care, and the state-wide Planned Care for Better Health program, which aims to reduce hospital admissions for patients with complex medical issues.

Victorian Premier, Daniel Andrews, said around the country the pandemic had put enormous pressure on healthcare systems, and part of that is because, through no fault of their own, people have delayed going to their GP and accessing primary care.

“Every day, it gets harder to access a bulk-billing GP.

“Victoria and NSW are doing something about it.

“We know and appreciate that the Commonwealth are investigating longer-term support for primary care, but we also know we need to act now to support healthcare systems across Australia’s two biggest states,” Andrews said.

NSW Premier, Dominic Perrottet shared this sentiment.

“Across the country, state and territory health systems are under pressure as a result of the pandemic and we need to boost support so communities can continue to access the care they need.

“We are leading the way to adopt a new model of care by investing in our communities to ensure people can access free health care.

“We continue to work with the Commonwealth to make sure we have long-term solutions to offer communities first-class healthcare and provide our frontline health workers with support they need,” Perrottet said.

Victorian Minister for Health, Mary-Anne Thomas said this initiative would free up beds in ED for those with critical needs, and fast track non-emergency patients so they can receive the treatment they need in a more comfortable setting.

NSW Minister for Health, Brad Hazzard said emergency departments were under significant pressure.

“Coupled with the ongoing issue of aged care and NDIS patients occupying hospital beds, we needed a measure to help try and relieve demand on our health staff now.

“Hopefully this expanded initiative will give everyone a little more breathing space,” Hazzard said.

It is predicted over 50,000 nurses and midwives held rallies outside hospitals all over NSW on September 1.

The New South Wales Government is yet to comment on the matter.


Community members looking to support nurses in NSW can encourage their local MP to push for mandated staff-to-patient ratios, as well as sharing their own stories as a nurse, someone who knows a nurse or a patient that has witnessed nurses stuggle with their workload.

Unions New South Wales also currently has an online petition in circulation asking the state Premier, Dominic Perrottet for a pay rise, more secure jobs, better working conditions and stopping privatisation.

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