Nurse In Australia » Nursing News

Controversial Midwife Laws Passed by Parliament

Ross — Thu, 25 Mar 2010 09:35:00 +0000

A dramatic but somewhat controversial reform has been passed by parliament last week allowing midwives to provide Medicare funded care in Australia for the first time.

This means that under specific guidelines, women will be eligible to receive Medicare rebates for private midwifery care, and also some Pharmaceutical Benefits Scheme (PBS) rebates for particular tests and medications.

The government is also supporting midwives access to professional indemnity insurance, which has been unavailable to midwives since 2001.

Summary of Reform

Midwives will be able to provide Medicare-funded care for the first time.
A national register will be set up, instead of current State bodies.
Indemnity insurance will be a registration pre-requisite.
No midwives have been indemnified since 2001.
New laws fail to provide for midwives offering home births.
Framework includes a request for midwives to form a collaborative relationship with a doctor.
Midwives will require doctor to sign-off to access Medicare insurance and pharmaceutical benefits.

- source: The Daily Examiner

These new laws represent a fairly significant step forward for midwives and have the potential to greatly improve women’s access to care by a primary midwife. They have also raised some controversy however, with home birth advocates in particular feeling that they have been left short-changed by the deal.

Under the new laws, the government will provide support for indemnity insurance for midwives and include a two year buffer for those having trouble finding providers, however the insurance support will not be extended to include home births.

Others have also raised concerns over the specifics of indemnity insurance:

“What worries me the most is that midwives’ being without indemnity insurance is going to drag on and on,” says Gail Baker, Registered Midwife and operator of home birth services. A Grafton-based midwife, who did not wish to be named, said the laws gave doctors ‘veto over midwives’. To be eligible for a Medicare provider number, midwives will need the sign-off of an obstetrician.

“This provides an opportunity for doctors to have power over a qualified, experienced midwife,” she said. The midwife called for a ‘publicly-funded home birth service’, which would come under the State hospital umbrella. “It’s a choice that should be available to all women.”

The Australian College of Midwives has also responded by saying the changes signal a significant step forward, but they call on the government to ensure that midwives who offer homebirths can also be insured.

ACT Australian Nursing Federation spokeswoman Jenny Miragaya suggests that it may take some time for the changes to filter through to the community and private sector, but agrees that “ultimately the change should lead to better healthcare.” (ABC News)

** Thanks to Peter McCartney for bringing these new laws to my attention

National Registration Coming to Australia

Ross — Mon, 07 Dec 2009 14:50:04 +0000

For those who are already Nurses in Australia, you would be aware that Australia uses a system of Independent Registration for each State or Territory where you work.

This means that your registration is only valid for that particular State, and you need to seek registration in other places if you intend to work there.

All this is changing as of 1st July 2010, when the first national registration and accreditation system comes into effect throughout Australia.

The Council of Australian Governments has signed off on an Intergovernmental Agreement on the Australian health workforce, which includes the following ten health professions: chiropractors; dental care practitioners; medical practitioners; nurses and midwives; optometrists; osteopaths; pharmacists; physiotherapists; podiatrists; and psychologists.

This means that registration will be valid Australia Wide, and a single Nursing & Midwifery Board will function to oversee the following:

Registration of nursing and midwifery practitioners;
Development of nursing and midwifery profession standards;
Handling of notifications and complaints in relation to the profession; and
Assessment of overseas trained practitioners who wish to practise in Australia.

More information can be found on the Australian Health Practitioner Regulation Agency (AHPRA) website, and minutes from the latest meetings related to Nursing and Midwifery can be found on the Nursing and Midwifery Board of Australia website.

Obese? Get to the back of the line, thanks…

Ross — Tue, 24 Nov 2009 14:54:07 +0000

credit: Kyle May

An Ipswich MP has suggested that obese people who are unwilling to change their lifestyle should have to wait longer for medical treatment.

From the article at Queensland Times:

Jo-Ann Miller, Labor MP for Bundamba, said people who were living on a “Macca’s” diet were placing an intolerable strain on Queensland Health.

Ms Miller has called on her own government to do more to educate Queenslanders about how to eat healthily and manage their own weight.

But she believes patients whose health problems have been caused by being overweight or by smoking – but refuse to change their habits – should be pushed to the bottom of the queue for medical treatment.

“If things keep going how they are, there won’t be a choice but to get tough,” Mrs Miller said.

“Every person in this country must realise that their health is their responsibility and that in future years we just might be facing a situation where a rationing of health services may become a reality,” Mrs Miller said.”

An interesting call, and one that I believe is not completely without merit. The figures speak for themselves – obesity and obesity related problems account for a huge percentage of hospital presentations, equating to billions of dollars in costs to the taxpayer.

Heart disease treatments, such as drugs, angioplasty, cardiac bypass procedures, valve replacement and cardiac transplant are very expensive.

An angioplasty for a patient who has had a heart attack costs more than $7000, a coronary bypass would cost about $23,000 while there would be many other costs involved with each case, such as the ambulance, intensive care, and rehabilitation.

Mr Lucas said it was reasonable communities would have to make a decision about how much they are willing to spend on health care before it gets to the point where state and federal budgets were spent on nothing but health.

“It is clear that the health of Queenslanders and the health system is under threat from chronic disease,” he said.

The Queensland Chief Health Officer’s 2008 report said ten obesity related diseases were included in the 15 diseases which drove the 56 per cent increase in health care expenditure in Australia between 1987 and 2000.

The net cost of loss of wellbeing due to obesity in Australia is valued at $50 billion with about $10 billion in Queensland.

So do we focus more time & money on primary health care, addressing obesity early on in a bid to reduce the figures before they cause further bulging strains on our health system?

Certainly, this sounds like a great idea, however the situation is a little more complex than it may first appear.

On the face of it I would say yes – reducing obesity = reducing ridiculous amounts of money spent on obesity related problems. But how do you determine whether or not someone is trying to address their obesity? How do you differentiate those milking the system & those genuinely struggling? What if you’re an obese child? Smoker vs non-smoker? How do you convince someone that they can take action to reduce the risks of extremely serious side effects and complications, if only they can make some serious changes to their diet, exercise & lifestyle regimes?

Should we encourage a cut-throat approach, making assessments on weight alone? ie: “You’re fat, therefore get to the back of the line & sort that out, then we’ll help you out.”

Obesity related problems are many and varied, and there can be no denying that they cause major strains on hospitals and the health care system as well as the individual. According to Stanford Hospital, just some of the health related issues related to obesity include:

high blood pressure – Additional fat tissue in the body leads to an increase in the workload of the heart because it must pump more blood through additional blood vessels.
diabetes – Obesity is the major cause of type 2 diabetes. Even moderate obesity dramatically increases the risk of diabetes.
heart disease – Atherosclerosis (hardening of the arteries) is present 10 times more often in obese people compared to those who are not obese. Coronary artery disease is also more prevalent because fatty deposits build up in arteries that supply the heart.
joint problems, including osteoarthritis – Obesity can affect the knees and hips because of the stress placed on the joints by extra weight.
sleep apnea and respiratory problems – Respiratory problems associated with obesity occur when added weight of the chest wall squeezes the lungs and causes restricted breathing.
cancer - In women, being overweight contributes to an increased risk for a variety of cancers including breast, colon, gallbladder, and uterus. Men who are overweight have a higher risk of colon and prostate cancers.
metabolic syndrome – The National Cholesterol Education Program has identified metabolic syndrome as a complex risk factor for cardiovascular disease.
psychosocial effects - Overweight and obese persons are often blamed for their condition and may be considered to be lazy or weak-willed. It is not uncommon for overweight or obese conditions to result in persons having lower incomes or having fewer or no romantic relationships.

What do you suggest should be done about this serious problem?

Should nurses light patient’s smokes?

Ross — Wed, 28 Oct 2009 11:35:54 +0000

An interesting situation regarding smoking and patient’s rights has developed in Tasmania this month, opening up a whole new world of questions on nurses obligations, rights and rules at work.

The heart of the issue is that A wheelchair bound, tobacco addicted MS sufferer has had his smoking privileges canned, after nursing staff have been prohibited from lighting his cigarettes.

From The Mercury:

“A Tobacco-addicted patient and his nursing home are at odds over regulations that stop staff helping him to smoke.

Brendan Nutting, who is paralysed from the neck down and has lived at the home for 2 1/2 years, received help from staff when the Tasmanian Health and Community Service was owned by the Tasman Council.

But, in February the Hobart District Nurses took over the home, and from next month will enforce a policy that prohibits staff from lighting Mr Nutting’s cigarettes, which are held in a robotic arm attached to his wheelchair.

The home’s managers say their hands are tied by strict occupational health and safety regulations but Advocacy Tasmania and the Multiple-Sclerosis Society say bureaucracy is prevailing over common sense.”

And the response from Hobart District Nurses Chief executive is that there is potential for further legal action if the practice were to be allowed, as well as endangering the health of employees.

“We have a world that is more than aware of the health dangers of passive smoking and as an employer we have to provide a safe workplace,” chief executive Kim Macgowan responded.

Mrs Macgowan suggested that the family were still able to help him smoke, and the nursing home would provide nicotine patches if desired.

“We haven’t stopped anyone from smoking, we simply said staff couldn’t assist people to smoke,” she said.

What’s interesting is that a lot of the decisions that have been made appear to be in order to reduce the risk of litigation in years to come.

“I go back to the asbestos incident and what that tells us is this will expose us to the risk that 20 years down the track people will be knocking on our door and saying I have cancer and this workplace contributed to it. I simply can’t allow for that.” Mrs Macgowan added.

The patient also had a bit to say on the topic:

“I’m stuck in here — I’m too young to be in a nursing home. Now I can’t even have a fag.”

“This is supposed to be my home. I’m supposed to have rights. The staff are happy to help me but it’s just the ridiculous system — there is no common sense.”

“It is a prick of a disease, I have to rely on everyone else to do everything for me,” he said.

What do you think? Is this an act of common sense, or politics gone wrong?

Damning Hospital Reports, Government Takeovers… and all that jazz

Ross — Thu, 15 Oct 2009 13:55:35 +0000

credit: EMS_EMT

Who should run our hospitals? Are our standards still comparatively high, or slipping further into embarrassing depths?

Back in 2007 (before winning the poll, interestingly enough) PM Kevin Rudd vowed to fix the Australian health system by mid 2009, or else a move would be made to take control of public hospitals.

In May ’09 we were given an indication of the government’s intention to renege on this issue, when we heard that “the Rudd Government is expected to stop short of a financial takeover of public hospitals and instead seek control of other health areas including outpatient care and community health services.”

According to The Australian, a final decision on a takeover move has now been delayed until early 2010, to “allow for further consultation on the National Health and Hospitals Reform Commission’s final report, released in July.”

Responses to the Government’s Stance

The backlash over this move has made Kevin Rudd an easy target, and probably rightly so.

Family First leader Steve Fielding has recently stated “The health system is still stuffed and the Rudd Government has reneged on its promise to the Australian people.”

Opposition Leader Malcolm Turnbull has responded with “The critical thing is that Mr Rudd be held to account for his promise. Let’s be quite clear about this. In 2007, Mr Rudd said to the Australian people he would fix the public hospital system by 30 June this year or he would take it over. And he has done neither. He hasn’t fixed it. Things have gone backwards and he hasn’t taken it over.”

Are they right? Let’s see what the Australian Medical Association (AMA) has to say on our current standards or health care.

AMA 2009 report: Another year of overall decline

Pressure is now increasing on the Rudd government to make good on their promises as the Australian Medical Association’s 2009 report on public hospitals shows “another year of overall decline in emergency department performance and increasing elective surgery waiting times.”

According to AMA president Dr Andrew Pesce, extra funding by the Rudd government is yet to bring any improvement in Australia’s public hospitals.

“Our report card shows objectively, slowly, things are deteriorating, access in emergency departments is worse, waiting times in emergency departments is worse, on all measures our public hospitals are gradually getting worse,” Dr Pesce told reporters this week.

“Where has that money gone? Why are things still getting worse? The current funding for the public hospital system is dysfunctional to the point that extra funds don’t deliver results.”

Interestingly enough, it appears that the situation might be even worse as the report also stated that hospital data can be “manipulated to cast a better light on achievement of benchmarks for political purposes”.

Mr Rudd responded by stating he would take a ‘very dim view’ of any state-based attempt to be ‘cute’ in reporting what was going on in public hospitals. “I basically agree with them, there is a real problem out there,” Mr Rudd stated to reporters. “And therefore, the Australian government, rather than simply pushing this problem under the carpet, believe it’s time we have a fully fledged national debate about how we fix this system for the long term.”

Changing our Health Care System

The situation is extremely complex. I don’t believe on any level that it’s as simple as throwing more money around in the hope that our waiting times improve, our ambulance ramping problems stop and our hospitals can function more efficiently.

I can tell you with absolute certainty that when wards are full, admitted patients occupy acute ED beds. And this is not a great thing.

On the surface, comments like “build more wards” and “get more staff” would appear to fix the problem. However, “more wards” soon fill up, leaving us with the same problem – emergency beds are filled with admitted patients who are stable, or at least have a provisional diagnosis and plan of care. The incoming patients en-route to hospital, those ramped in corridors and sitting in the waiting room, do not.

So what else do you do to fix the problem? Fast track patients who are likely to go home from emergency rather than being admitted? Put on more emergency doctor’s and nurses, and build more spaces to see people? Implement strategies for early intervention when the capacity to deal with a trauma situation is diminished? Sure, all these things and more.

Ultimately however, I believe there needs to be a complete restructure and change in our health care system. Meaning, high occupancy levels, ridiculously long emergency wait times and corridored patient’s being a daily feature is just not on. Whether or not a government takeover would ultimately improve these key areas remains to be seen.

After all, I would suggest that most Australian’s rank having high standards of health care to be very important, am I right?

Overworked Doctors: Just Add Caffeine?

Ross — Thu, 24 Sep 2009 03:18:02 +0000

credit: SuperFantastic

I was bemused by a recent news articled titled Tired Doctors told to Drink More Coffee, from The Courier Mail.

The gist of the article is that some doctor’s are working crazy amounts of shifts back to back, and are often on call with little or no break in between shifts.

Part of the fatigue policy in public hospitals, or a current strategy to cope with this crazy deprivation of a basic human need (sleep), appears to actually be “drink more coffee!”

From the article:

“The Courier-Mail yesterday reported the confessions of junior surgeons and medics whose exhaustion-induced errors had killed or hurt patients during “on-call” shifts of 30 to 80 hours.

But a guidelines document underpinning QH’s Fatigue Risk Management System claims “solutions such as ‘we need more staff’ might not be achievable or effective in managing a fatigue risk.”

Instead, the 102-page document deems the “strategic use of caffeine . . . to be beneficial” as a fatigue fighter for doctors on marathon duties.

“The recommended dosage for a prolonged and significant reduction in sleepiness during a night without sleep has been suggested at 400mg of caffeine . . . equivalent to about five to six cups of coffee,” the document states.”

Wow, interesting stuff. Don’t get me wrong, I’m a big fan of caffeine myself, although I’m not so sure it’s the answer to the overworking problem. You can get an interesting picture of the situation by reading these articles:

Overworked doctors endangering patients
We’re killing people, say over-worked doctors
No break for doctors despite girl’s death
Patients dying at the hands of doctors working for days on end
Tired Aussie doctors told to drink more coffee

Now there’s even a web site devoted to the cause: Dead Tired Doctors.

As far as nurses go, I think that a fair number of nurses do back to back shifts from time to time, though this happens (hopefully) fairly infrequently so that there’s appropriate break time in between shifts.

I know that a huge amount of nurses are coffee / caffeine drinkers also, and I believe the jury is still out over risks/benefits of coffee. When it comes to how much, how often and that kind of thing, it’s probably best to throw the “all things in moderation” line out there. As far as overworking goes, caffeine really is a short term measure. Surely the best thing to counteract tiredness & ensure patient safety is a decent break & a sleep?

A&E Staff Lying Down on the Job: So What!

Ross — Wed, 23 Sep 2009 09:43:34 +0000

credit: debora_rtv

Bureaucracy vs Common Sense

Staff members from Accident & Emergency at Great Western Hospital in Swindon, UK have recently been suspended after their role in the lying down game.

According to BBC News:

“The game involves being pictured lying down with arms by your side and toes pointing towards the floor.

It is understood staff were pictured lying down on the hospital’s resuscitation trolleys, ward floors and the Wiltshire Air Ambulance helipad.

Seven hospital staff have been suspended for their part in the game, played in mid August.”

A hospital spokesman, Dr Alf Troughton has also added his two cents to the situation, stating “A number of staff were suspended following allegations of unprofessional conduct while on night shift duty in the hospital during a weekend in August. This did not involve patients and we are satisfied that at no time was patient care compromised.”

So What!

I’d like to add my own personal SO WHAT! to this whole situation.

Anyone who has spent any time working in any emergency department knows that we work hard, and we play hard. Spirits are generally high & in down times we try to have a bit of fun. Why? Because that’s the only way to cope! Believe me when I say the busy times can be absolutely emotionally, physically and mentally draining.

You can be assured that this game would not have been played when there was a trauma patient rolling in to a resus bay. Even the hospital confirmed this, “This did not involve patients and we are satisfied that at no time was patient care compromised.”

I don’t think I’ve worked in any emergency department that didn’t use humour from time to time (1%) to offset the rest of the crazy times (99%). To the 7 people who have been suspended, it’s a real shame. These are likely competent, qualified and very needed staff members who were just trying to enjoy themselves in down time.

Update:
Today I came across the following anonymous comment posted on NursingTimes.net:

“As a former member of staff in this department,The full story has not been released, Initially over 40 people were suspended, some of these being Drs however the ED consultant refused to accept this and the Drs are now back at work the nurses however have no real support and these are the ones who are being made an example of – Shocking really as it is a good if busy unit and yes they were a bit silly and it may have gone a bit far but this is an over exageration of management in my opinion.”