Australia's insurance crisis and the inequitable treatment of self-employed midwives

Based upon a review of articles published in Australia's major newspapers over the period January 2001 to December 2005, a case study approach has been used to investigate why, when compared with other small business operators, including medical specialists, Australian governments have appeared reluctant to protect the economic viability of the businesses of self-employed midwives. Theories of agenda setting and structuralism have been used to explore that inequity. What has emerged is a picture of the complex of factors that may have operated, and may be continuing to operate, to shape the policy agenda and thus prevent solutions to the insurance problems of self-employed midwives being found

Industrial action in Western Australia's public sector essential services

Workers in essential services professions protect the safety, health or welfare of a community. Any disruption to the operation of essential services can mean that communities are unable to function effectively. For this reason, additional complications arise when people working in essential fields look to take industrial action. This thesis reflects on the often-competing interests of protecting essential service workers’ liberty to take industrial action (or right to strike) while upholding the life, safety, health or welfare of the community. The purpose of this thesis is to consider whether essential service workers in Western Australia’s Public Sector have sufficient freedom to access their right to strike; or if legislation is overly restrictive in this regard. Secondary purposes to this thesis include consideration of whether Australia’s Federal industrial relations system is more facilitative than Western Australia’s industrial relations system for essential service workers taking industrial action, and, whether some essential service professions should have greater limitations than others when taking industrial action. These issues will be addressed in light of the industrial situation for professions such as policing, teaching, firefighting and nursing. A macro assessment of the historical and present approaches to industrial action taken by essential service professions in Western Australia and Australia will be presented. The macro assessment suggests that industrial actions by core essential services is rarely taken, and, when done, it is reactive and the outcome of sustained frustrations over pay and working conditions. A comparative analysis of Australia’s compliance with international labour obligations on this issue highlights several shortcomings in Western Australia’s labour laws. These shortcomings mean that there is a need for Western Australia to enhance its proactive dispute resolution mechanisms to facilitate better access to the right to strike, and to bring domestic laws into better compliance with international obligations

Patricia Violet Slater : a remarkable leader in the nursing profession in changing times

Patricia Slater opposed the entrenched traditional system of educating nurses in hospital programs and, in the years 1960-1983, she was an advocate and activist for tertiary level ducation for nurses in the general education system. Ms Slater’s educational expertise and unique position in nursing affairs, positioned her to progress nursing education at both undergraduate (basic) and graduate (post basic) levels and to take a leading role in the reform of nursing education. In this biographical account of Ms Slater’s professional life, her contribution as a pioneer and key player in the late twentieth century radical reform of nursing education, is distinguished from the collective activity of the nursing profession. The 1950s-1970s, highlighted many shortcomings in nursing practice drawing attention to the inadequacy of the contemporary preparation of nursing students. The traditional nursing education system, couched as it was in the cultural ethos of nineteenth century and rule driven, is identified as a major contributing factor to the apparent stasis in educational growth and development in Nursing. Social, cultural and political ideologies, to which the nursing profession was subject, worked to constrain and contain the profession, contributing to the apparent powerlessness of the profession to readily adjust and rectify its position. Chief among these influences was firstly, the domination and control of the medical profession over the health system and all health matters. Secondly, paternalism, that kept women in society and in the workforce subordinate to men. Thus nurses, being mostly female, were also professionally subordinated in the workplace being subject to medical control and direction. Thirdly, the Nightingale legacy of discipline and obedience in combination with the apprenticeship model of nurse education and the hierarchical organisation of nursing work, combined to encourage passive and conservative traits in nursing students that persisted over time. Ms Slater returned from nursing studies in America in 1960 with a vision as to how the nursing profession in Australia could advance and prepare nurses able to carry the profession forward, to determine the role and function of the nurse and the education required to develop nursing students at all levels. It would not be until the 1970s that sufficient numbers of nurses were ready to support the radical solution that Slater advocated, the transfer of nursing education into the general education system. Achieving this aim drew support from leading nursing organisations and the profession’s collective effort, sustained for over a decade, ultimately proved successful. Ms Slater’s thinking on nursing education, her vision for the nursing profession’s future, her philosophy and values in respect of Nursing, are drawn from her published work and some unpublished papers. Finding little to give insight into her personal reactions to events in her professional life, I approached individuals who had worked with Ms Slater ranging in time from approximately 2-12 years. Sixteen individuals were interviewed to gain their perspectives on events and their views and perceptions of Ms Slater: all but four were former employees. Interviews were taped verbatim, transcribed and reviewed by participants, all of whom agreed to be identified in the study. The official records of the College of Nursing, Australia and the then Royal Australian Nursing Federation, provided further primary source material together with the many reports of inquiries into nursing education. A diverse range of material was used to place Ms Slater’s life and the Nursing profession as a whole, in the social, cultural and political context of the times. Nursing in Australia was compared with like countries in the same time period. It was established that all were facing similar problems for much the same reasons. Patricia Slater’s leadership and expertise, were essential components in the successful achievement of tertiary level education for nurses. As a result, in the years 1984-1994, the nursing profession moved from a skilled craft towards becoming a knowledge based discipline, the equal of other health professions. The change in nurse education at that time, was as radical as that introduced to Australia by the Nightingale nurses in 1860s, in that the position and status of nurses and Nursing was radically changed on both occasions. The story of one of the most important Australian nurse leaders of the twentieth century is related for the first time in this work.Doctor of Philosoph

Workplace aggression experiences and responses of Victorian nurses, midwives and care personnel

Background: Workplace aggression is a major work health and safety, and public health concern. To date, there has been limited investigation of population level exposure and responses to workplace aggression from all sources, and little evidence on the experiences, reporting and support-seeking behaviour of nurses, midwives and care personnel in Australian settings. Aim: To determine the 12-month prevalence of aggression experienced by nurses, midwives and care personnel from sources external and internal to the organisation, and the reporting behaviours and support sought from employers, health services, Trade Unions, work health and safety agencies, police and legal services. Methods: An online survey of the membership of the Australian Nursing and Midwifery Federation – Victorian Branch was conducted between 1 st May and 30th June 2017. Findings: In the previous 12 months, 96.5% of respondents experienced workplace aggression, with 90.9% experiencing aggression from external sources and 72.3% from internal sources. A majority indicated they just accepted incidents of aggression, and most rarely or never took time off work, sought medical or psychological treatment, or sought organisational or other institutional support, advice or action. Levels of satisfaction with institutional services were mostly neutral to poor. Discussion: Victorian nurses, midwives and care personnel work in aggressive and violent workplaces. The incivility endemic in health care likely sets the climate for the generation of and exposure to so much explicit aggression and violence. It appears that any systems or processes instituted to protect health care personnel from harm are failing. Conclusion: More targeted and effectively operationalised legislation, incentives and penalties are likely required. Further research may elaborate the extent of the impact of exposure to workplace aggression over time

Foreign Labor Trends: Australia

Foreign Labor Trendsaustralia_2003.pdf: 615 downloads, before Oct. 1, 2020

Psychiatric triage nursing : the new frontier

"The overall aim of the study was to provide a comprehensive definition and description of psychiatric triage nursing in Victoria."Doctor of Philosoph

History of the Ballarat Trades and Labour Council 1856-2000

The Ballarat Trades and Labour Council (BT&LC) is the second oldest trades and labour council in the world, founded in 1883, although it has existed in various forms since 1856. This thesis examines the history of the BT&LC in terms of five related themes – ideological conflict, solidarity, labourism, masculinity, and spatiality. I approached this research project from the perspective of a labour historian, which also included issues of gender. While being resolute in writing the history of this institution, my aim was also to capture an aspect of Ballarat history that had not been examined before – the role of workers and their families. The BT&LC sets the parameters of its history from the Eureka Rebellion and gaining the Eight Hour Day for Ballarat stonemasons in 1856 a fortnight after their Melbourne counterparts. Since that time, the BT&LC has built the substantial Trades Hall in Camp Street, which it still occupies and hosted the Seventh Intercolonial Trade Union Congress in 1891 when the decision to seek political representation was formally endorsed. It witnessed the emergence of the new elites and the ideological struggle that became more bitter as the Catholic Church, Protestant Freemasons, and the very active Communist Party battled for supremacy, with it ending inevitably in a divisive public separation in 1955. The Whitlam years saw their resurgence with a new face to unionism as public sector workers, teachers and nurses became militant and women began to take significant roles. In Ballarat while this has meant political ascendancy since 1980, the success of the political wing has not necessarily been mirrored in the fortunes of the peak union organisation. Ballarat’s overall union membership has declined. The old loyalties have been difficult to maintain and the capacity to build new alliances is challenging. However, one thing remains clear: strong individuals who understand the underpinnings of solidarity and unity have ensured that the Ballarat Trades and Labour Council has remained a significant feature of the Ballarat public landscape.Doctor of Philosoph

Gendered relations to working time: enterprise bargaining outcomes in acute care and community nursing settings in Australia

In this paper we examine the outcomes of the 2001, 2004, 2007 Enterprise Bargaining Agreements between the Australian Nursing Federation (SA) and the South Australian Government with particular focus on union-based strategies for de-intensifying nurses’ labour in the acute and community sectors. Consistent with the theoretical and empirical research on time, the strategies employed in the acute sector reflect rational, linear, bureaucratic, logical and masculinist relations to time through the use of computerised time and task measures. Community sector solutions are characterised by cyclical, messy and highly relational feminised approaches to reducing work intensification. We argue that the outcomes of these two approaches are contradictory. The community-based solution of case management is less successful in reducing workload, but maintains worker control over the labour process, while in the acute sector, the highly Taylorist approach is successful in de-intensifying workload but at the cost of reduced control over the labour processes

Rationed or missed nursing care: Report to the ANMF (Victorian Branch)

In May to July 2015, 1683 nurses, midwives and personal care workers (PCW) and Assistants in Nursing (AiN) employed in public and private health facilities in Victoria completed the MISSCARE survey. This represents around 3 percent of the total number of nurses and midwives employed in the state of Victoria. The survey was administered via Survey Monkey by a research team from Flinders University in collaboration with the Victorian branch of the Australian Nursing and Midwifery Federation (ANMF Vic Branch). The Victorian MISSCARE survey is a modification on the original design developed by Beatrice Kalisch (2006). It contains eleven demographic questions, 23 questions dealing with working conditions including questions on staffing tools, 21 questions concerning missed care (care that is omitted, postponed, or incomplete) and 20 questions addressing reasons why care is omitted in the settings in which the nurse/midwives practice. Victoria is the only state in Australia to have mandated nurse-patient ratios. The state of Victoria is experiencing rapid growth in population. Missed nursing care is a global phenomena linked to the rationing of health care. Nurse researchers around the world are recording the levels of missed, delayed or rationed care. Nurses have always rationed care tasks, or prioritised them when work intensifies. Nursing assistants known as health assistants in nursing, have been employed in some public hospitals in Victoria since 2009. Patient satisfaction surveys conducted by the public hospitals in Victoria show high rates of satisfaction with nursing care, and the courtesy of nurses, and low scores for organisational issues such as food, restfulness of hospitals and waiting times. There is some overlap between the patient satisfaction surveys conducted in the public hospital system and the MISSCARE survey such as length of time taken for nurses to respond to call bells, patient education, hand hygiene and medication requests. Sixty-seven percent of nurses in Victoria are employed on a permanent part-time basis. This is higher than NSW where 48.3 percent of nurses are employed part-time permanent. Fifty-six percent of nurses work 30 hours or more in Victoria. Sixty-five percent of nurses and midwives prefer to maintain their current schedule. Over 22 percent of nurses said they worked overtime greater than 20 times in the last 3 months. Thirty-four percent of nurses and midwives worked 2 to 3 shifts over the last 3 months even though they were sick or injured, with 32 percent stating they felt an obligation to their colleagues to go to work. Fifty-three percent of nurses and midwives felt that there were adequate staff between 100 and 75 percent of the time. The remaining 47 percent felt staffing was inadequate between 50 and all of the time. Seventy-three percent of nurses and midwives had less than 9 patients per shift, with eighty-six percent reporting that they had fewer than 5 admissions per shift Rounding appears to be used in 53 percent of situations, although many nurses had not heard of the term. Nursing care tasks most often missed include skin and wound care, and glucose monitoring. The care missed is consistent across all three shifts, although some tasks are more likely to be missed on a particular shift; eg afternoon shift has higher scores for missing the promotion of PRN medications, while night shift staff report the omission of managing parenteral devices. Nursing care tasks such as turning patients, oral hygiene, prompt medication administration and patient education are least missed. Missed nursing care can be categorised into low, intermediate and high treatment. Lower priority care includes emotional support, patient education and discharge planning, and high priority care includes handwashing, IV/CVC lines, call bells, BSL, vital signs. Treatment (intermediate) related care is the most likely form of care to be missed. These include nursing specific tasks such as feeding, turning/positioning, wound care, administering medication on time, ambulation, mouth hygiene, and toileting. This finding is consistent with survey results from NSW. Variables with a direct impact on missed care include the hospital location (rural hospitals report higher rates of missed care), the use of rounding impacts on missed care, and staff adequacy. Reasons for missed care include urgent patient situations and unexpected rises in patient volumes which impact upon staffing issues. While just over 50 percent of nurses thought their ward was adequately staffed 75 to 100 percent of the time, unpredictable work increases such as increased admissions and discharges contribute to missed care. Other important reasons for missed care include: ‘Inadequate skill mix for your area’, ‘an unbalanced patient assignment’ together with an ‘inadequate number of assistive and/or clerical personnel’ and ‘supplies/equipment not available when needed’. Two hundred and eighty four nurses and midwives provided qualitative comments within the survey. Responses illustrated a stronger focus on nursing the budget, with participants indicating they were more aware of financial constraints or the need for profits than previous generations of nurses. Midwives reported that early discharge of mothers curtailed adequate patient education. Nurses and midwives targeted cost constraints, lack of adequate numbers of clerical and ancillary staff, particularly on night duty, the lack of mandated nurse-patient ratios in private hospitals, poor access to medical staff, patient acuity, and competing demands placed on nurses who are at the centre of the ward or unit. Consistent with survey results from other states, lack of access to equipment including medications also impacts on missed care. Nurses in Victoria also indicated that poor communication was a factor in missed care. When nurses were asked about personal issues that impacted on missed care they reported that their capacity to deliver uninterrupted care and an inability to attend case conferences as causing missed care. This was followed by the absence of hospital policies and inability to delegate work to others. The frequencies and types of missed care are significantly influenced by both hospital/clinical unit effects including hospital location and by individual nurse/midwife factors. Missed care shows greater variation within Victorian rural hospitals. The average frequency of missed care on Victorian afternoon and night shifts is significantly less than reported in NSW however, the average frequency of missed care on the Victorian day shift is equivalent to that reported in NSW. Employer type (private or public agency) was not associated with missed care by Victorian respondents The use of rounding practices in the clinical arenas presents as contributing to and preventing missed care dependent upon context. The rate and frequency missed care is defined by the type of care missed. Intermediate treatment related care is more likely to be missed than higher priority and lower priority nursing tasks. In Victoria, the morning shift is associated with the greatest volume of missed care, followed by the then afternoon shift and then the night shift. Country of origin of nursing/midwifery qualifications is associated with significant variation in the frequencies and types of care missed in Victoria. Age of the staff providing care shows a mixed but statistically significant influence on missed care in Victoria. The gender and the level of qualifications held by the Victorian nurse/midwife is associated with significant variations in treatment-related missed care. Staff employment status (both full and part-time employment) demonstrates variance in frequencies of Victorian missed care. The complexity of staffs’ ability to manage daily work tasks shows significance variation in missed care in Victoria.. Dissatisfaction with work teams has a statistically significant influence on Victorian missed care. Current job dissatisfaction has a statistically significant influence on Victorian missed care. Staffs’ self-rated level of their current health and the number of hours they are employed for per week are not associated with Victorian missed care. In order of magnitude, the reasons why Victorian care is missed care are issues associated with the provision of resources for care, communication tensions between care providers, workload (un)predictability, (dis)satisfaction levels with members of the team and workload intensity

Towards an understanding of occupational therapy professional practice knowledge in mental health services

This study critiqued historical, philosophical and political factors influencing occupational therapy (OT) professional practice knowledge in the context of public mental health services located in Victoria, Australia. The research was situated within the interpretive paradigm of scientific inquiry, using a hermeneutic process to construct and interpret five texts portraying the evolution of OT in mental health services. A series of conversations with key occupational therapists yielded material for further critical interpretation. Ethical approval was received from the Human Ethics Committee, University of Sydney. The first constructed and interpreted text situated early mental health services within the unique background of Australian convict settlements, 1788 - 1868. OT emerged within institutional environments echoing this past. The second and third texts interpreted OT professional literature, presenting a timeline of practice within mental health services. Occupational therapists implemented their craft-based practice within the psychiatric institutions of the 1940s and 1950s. Through the next two decades, occupational therapists made efforts to align practice with medical paradigms of knowledge before returning to occupation as a core of practice knowledge in later decades. Following closure of institutions during the 1990s, occupational therapists were challenged by relocation of services to community-based, multidisciplinary environments. The fourth text portrayed an interpretation of four transitions of practice, reflecting challenges influencing professional practice knowledge through five decades of practice. The final text interpreted six strands of professional practice knowledge, representing unifying threads woven through these decades. The study concluded that OT had a quiet, yet consistent role within mental health services in Victoria. Gender, changing social views and practice environments were significant influences on the evolution of occupation as a core of practice. The study adds to deeper understanding of the importance of practice knowledge for the development of the profession in complex socio-political environments