Nurses, death, and mourning

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Like all nurses of any length of practice, my clinical experience includes the most intimate moments of people’s lives. I suspect most laypeople think first of physical intimacies – bedpans and nakedness, though those are the least intrusive; for me and most of my colleagues, though, the real intimacies are less tangible – people who need to be strong for their families allowing themselves to be vulnerable with us; confiding long-held secrets and fears; making their dying days comfortable and calm; continuing care after their lives end. 

While nursing care and death work have been the foundation of my academic career, I realised today, after starting a response to ‘Nurses Grieve Too,’ an excellent guest post by Emily Rankin on Ian Miller’s blog The Nurse Path, that I haven’t written about it here. 

Like one of my favourite medical authors, American surgeon Atul Gawande, Emily introduces and closes her writing with the dying of a specific patient, while the body of her piece explores the emotion labour of grieving for and with our dying patients, wondering if we could have done more, and of needing to contain our emotions as we continue to care for our other patients.

Approaching her second year of registration, Emily is near the beginning of her career; I commemorated the 27th anniversary of my hospital-based education 45 days ago, and I long ago lost track of how many of my patients have died on my shift. I certainly don’t remember all of them, though there are some I will never forget. 

Like many nurses, I prioritise the care of the dying – as well as pain relief, sedation, and secretion management (do they stiffen or grimace when turned? Are their eye movements rapid? Is their breathing shallow, rapid, laboured, moist?), fundamental nursing practices like smoothing sheets to prevent uncomfortable wrinkles, flipping pillows to the cool side, frequent mouth care to avoid caked secretions and dry lips, position changes, and back rubs make a huge difference. Helping someone die well is a mitzvah, for them, their loved ones, and it also helps us.  

The deaths most of my friends and I remember most vividly are where the dying was not peaceful. Where the medical team, the family, sometimes (but rarely) the patient themselves pursued treatment long after the benefits outweighed the toll; where someone bleeds to death as we stand by, helpless to stop it; where end-stage organ failure means the only doses of pain relief high enough to treat condition A would kill them thanks to underlying disease B, so we have to see them suffering on their inevitable trajectory to death. 

We remember the young people, whose time was cut cruelly short; the confused and demented people, terrified by things only they can see; and the unexpected deaths of those who seemed to be doing well. 

I have shed tears for my patients, and for the grieving loved ones they’ve left behind; I hope that those who’ve seen the glisten of tears, the pinkening of my nose, also see compassion, without loss of professionalism. But I have not wept – whatever distress we feel, whatever we’ve seen and felt, the expectation is always that we keep going, absorb the experience, because it’s part of the job. 

I have once been offered formal debriefing, after a patient I didn’t know committed suicide on site. It was disruptive, distressing, and chaotic on several levels, but not close to the most traumatic experience I’ve had. Without in any way blaming my management (for this attitude pervades the profession at all levels), it is only these spectacular deaths that we’re ‘supposed’ to be troubled by – not the elderly man drowning in secretions we can’t stop, the young mum with congenital vasculopathy, the younger man with breathtakingly rapid progression to advanced HIV, the woman who’s been cared for by us over the eight year decline from neurodegenerative diagnosis to death, or the man whose decision to end dialysis was received with a diagnosis of depression and course of electroconvulsive therapy. 

I believe this lack of acknowledgement, along with intimacy, little direct control, the honour and responsibility of caring for people at their most vulnerable, and only rare opportunities to direct the residue of that labour and emotion, plays a part in why some of us speak to our patients while performing post-mortem care: we get to say goodbye, give uninterrupted care, and complete a journey that we have uniquely travelled.

Should we return to hospital training?

I woke this morning to heated discussion among my social media peers about One Nation’s policy on nursing education in Australia 

[source, via Ian Miller at The Nurse Path]

I was part of one of Victoria’s last hospital-based nurse training groups, so I had opportunities to compare our experience and knowledge with my then-college educated peers, and with university-educated nurses in the two-plus decades that RN qualifications have been solely via university. 

There were undoubtedly advantages to the way I learned how to be a nurse. To start, we were paid from day one, whether we were in class, on the floor, on specialty placements, or on leave – 40 hours a week, 52 weeks a year, until we qualified. That meant that, unlike the majority of today’s students, we didn’t have to balance the needs of study and placement with survival. 

We knew early on whether or not actual nursing was really what we wanted to do – shift work, short changeovers, abusive doctors, terrifying charge nurses, rude relatives, violent patients, every single disgusting fluid our bodies produce, bursting wounds, maggots, caring for people sicker than we knew it was possible to be and still breathe, the helplessness of not being able to make a difference to someone’s anguish, watching people treated past usefulness and into cruelty, caring for the bodies of the dead, making mistakes that could have (and sometimes did) make patients worse or even die, the heavy cloak of being literally responsible for strangers’ lives every single day, were all known to us within months. 

Our educators taught us in the classroom and on the floor – they knew all of us by name, because each intake (three per year) was capped at 60-65 students; when I graduated I confided in one of my teachers that, had there been cardiac questions on our state exam paper, I’d have failed. Though she’d taught our cardiology block more than 18 months earlier, June drily replied, “Yes, Tara, I know.”

Our progress was monitored consistently, every step of the way, with ward reports for every rotation longer than two weeks. Those charge nurses cut no slack, and we lived in fear of bad reports – we could lose our career, job, and home in one fell swoop. 

We lived together on site, at least for the first six months, which meant both strong team building and ready access to peers and students ahead of us when we had questions or needed debriefing. 

And there’s no question we had strong clinical skills: well over 4,000 hours (100 weeks+ of 40 hours of patient care) of general and specialty medical, surgical, theatre, emergency, paeds, radiology, midwifery and neonates, psychiatry, RDNS, community health – I knew where I wanted to work as an RN, and what I had no interest in at all. 

All of which sounds like a really good grounding for our nursing workforce. Here’s the other side. 

We were employees first, students a poor second – our rotations were based on where they needed hands. I remember a two month period of fortnightly rotations: two days off, a PM shift, nine AMs, two days off, and a new ward – no time to become part of a team, to learn the specialty, to even know where all the equipment was. 

We were frequently frighteningly out of our depth. I vividly remember being told six hours into one shift that I was needed on another ward to special (nurse 1:1) a patient. I had almost no time to hand over my patients to colleagues whose workloads just jumped without warning, and my sole introduction to the patient was, in essence, “they’ve got an axilla DVT [clot in a  deep vein running under the armpit]. This infusion’s [a medication that breaks down clots]; don’t leave their side; don’t take down the dressing; buzz if they’re symptomatic [have signs the clot’s moved or the medication’s caused abnormal bleeding].” Then she left. 

I was so terrified I didn’t speak to the patient. At all. 

I wasn’t familiar with the kind of pump used. I’d only ever heard of streptokinase, and didn’t even know it could be used as a continuous infusion. 

I didn’t know what I was looking for, or what the management plan was. I had no access to the patient’s history, and my only way to contact other nurses or a doctor was to press my patient’s button, then wait. 

Nobody checked in on me until the night special came. 

I was so relieved to see her that I almost cried – and I can count on my digits how often I’ve cried at work. My overwhelming feeling as I left was relief that my patient was alive. 

When I arrived on my ward at 7AM the next morning as was told I was going back to the special, I thought I’d vomit. 

The plan was to transfer my patient from this ward to another ward I didn’t know, via radiology. We went down to imaging, then waited in a corridor for an hour until an orderly took us up to the new ward – I had no way to get help, should I have needed it, except to yell. 

On the new ward I was reminded by the charge nurse not to leave the patient, who I was still afraid to talk to. Whenever I buzzed to get a pan for my patient, a responding nurse would tell me the pan room was just outside. Whenever I went to the pan room the charge nurse would see me and tell me not to leave the patient. 

I found blood in the infusion line. I had no idea how to get it out, how long the IV could be stopped for, and I was afraid to ask. Fortunately I knew not to bolus [give a larger dose over a short time] streptokinase, and went out to the desk. The charge nurse was irate that I’d once again left my patient. When I told her about the blood, she directed me to get a new infusion set. As I didn’t know where anything was on this ward, I ran down two flights of stairs the old ward, got a set, ran up the stairs, and found the nurses had fixed it already. 

Nothing bad happened – I don’t know what happened in the long term, but when I finished my shift the patient was fine. But 25 years later than remains one of my ten worst shifts – and the others include a Coroner’s case, a patient fall with fractures, a patient so severely vomiting blood that the room looked like a murder scene, a patient bleeding to death in front of me, accidentally increasing an IV medication that could have been fatal, and the death of a young mum. 

We were thrown in the deep end with one floaty, and expected to swim. 

And here’s the thing. Our patients are so much sicker now, they have more comorbidities, and their stays are shorter. Almost without exception our patients are too vulnerable to entrust to early-level students with almost no supervision. If you take nothing else away, know this: patients would die, and it would be the individual students, not the system, held to account. 

Nursing and midwifery have transitioned from vocations to professions, and education has been a vital part of that change. Health care today demands a far more technical, detailed, complete knowledge base than hospitals can provide. The old method of half a dozen interchangeable students, overseen by one or two RNs, is long gone, and that means better patient outcomes. 

Which is not to say that change isn’t needed. 

Our students should be able to survive without working on top of study and placements – increasing Austudy to a reasonable amount would allow student nurses and midwives to focus on learning. 

Students’ placement assessments are currently done by clinicians, who have no training in it, often have no guide to expectations of proficiency at this placement, no easy access to processes for unsatisfactory performance, and who are supervising students and completing their assessments in addition to their workload, without compensation. Returning educators to the floor, one per ward, would help catch struggling students before they’re registered. 

The idea of nursing and midwifery as apprenticeships is right, though my analogy would be with medicos rather than tradies. 

Doctors must complete an accredited program post-graduation, that includes an intern year, residency, registrar experience, exams, and then specialist training. 

Nurses and midwives can apply for a graduate year position, somewhat like an intern year – they include a supernumary period, a preceptor, study days, supervision of clinical educators, and individualised goal setting. The cost of this is met by state government funding. 

Unfortunately, graduate funding is grossly inadequate – in Victoria alone we have 800 or so graduates, every year, who are unable to find a position. While the programs are theoretically optional, in practice it’s next to impossible to work without one. This is fiscally short-sighted: tax payers have subsidised the education of needed professionals, who now also have a hefty HECS debt they can’t repay, for a career they can’t pursue. 

Instead hospitals hire overseas-educated nurse said, who cost less in the short term because they don’t need as much support. Some of the best nurses I’ve worked with have come here after qualifying, and easily half of my locally-educated nurse friends have worked overseas. This reciprocity is a good thing all around, for individuals and the system. But it shouldn’t come at the cost of our early career nurses and midwives. 

Our nursing and midwifery work forces are aging – the average Australian nurse is mid-forties, and global shortages are projected within a decade. It makes sense to encourage the next generation to join us, but we need the funding to ensure the best candidates are attracted to degrees that will lead to jobs. Not debt. 

TL;DR? There was a time when hospitals were the best place to educate nurses. That time has passed, and it’s in all our interests not to go back. 

8/7/16
01:25
Addit: as The Conversation recently noted, patients are more likely to survive when cared for by a nurse with a degree (with thanks to Meta4RN) 

My feminism is inclusive: some thoughts on trans folk

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There has been a lot of coverage of trans gender issues in the media recently. In principle I think this is a good thing – visibility and awareness are first steps towards acceptance, and with trans youth suicide disproportionately high even among the cruelly elevated rate for LGBTIQ+ teens, knowing they’re not alone, that being trans isn’t synonymous with being rejected, alone, ostrasised, a freak, helps survival through these hardest years.

I’ve been saddened but unsurprised by many of the responses from the uninformed; I have been dismayed and bitterly disappointed by the positions of many who call themselves feminists.

I am a feminist for the same reason I’m a unionist – because I strongly believe that those without power, without a heard voice, whose contributions are underrecognised and under appreciated, need and deserve representation and organisation, a voice, recognition of their value and contribution, and power.

I am a cis woman. I have had my share of body hate and shame, but I have never felt as though my assigned gender was at odds with who I felt like. I have never been misgendered by my family, by my colleagues, by the world.

I have had people insult my size, but I have never had people deny who I am by deliberately using the wrong pronouns, or by using a name that is associated with all the pain, sadness, and erasure of my true self – what trans people often refer to as a dead name.

Nobody will deny me my identified gender based on how much I ‘look like a woman’ or feel comfortable interrogating me about my genitals. And if I have bilateral mastectomies, a hysterectomy, bilateral oopherectomy, a vulvectomy, and take hormone replacement, nobody will tell me that I’m no longer a woman.

I recognise that this is a privilege not afforded to my trans sisters, to gender queer and gender fluid people, and while I can’t and won’t speak for them, I can support them in private and aloud.

If you’ve made it this far, had you noticed that almost all the focus has been on trans women? If not, that’s not surprising – from talk shows to TV series, almost without exception coverage is of trans women like Laverne Cox and Caitlin Jenner. Chaz Bono is a rare exception, and that more because of his parents’ fame.

This relentless gaze on trans women is interesting. Perhaps it’s because some see trans women choosing to give up male privilege as more transgressive.* I suspect, though, that it’s at least as much about male sensibilities – first, the idea that trans women are somehow setting out to trick unsuspecting cis, straight men into thinking they’re cis women (because being attracted to a trans woman, in this Neanderthal mindset, is emasculating and shameful); and second, because we police female appearance far more than male appearance, so trans women who ‘pass’ are threatening, and trans women who aren’t sufficiently feminine (whatever the hell that means) are parodies or imitations or something. And all of this presupposes that trans women are transitioning for some reason other than a need to express and be recognised as their true selves.

Oh, and I hope all these exclusionary radical feminists embrace trans men as women. Well, I don’t hope that for the men, because that’s vile and I don’t want their identities erased, but I hope they TERFs are at least internally consistent. That means being happy with trans men in female bathrooms, women’s spaces, and taking positions intended for women. Because they don’t get to have it both ways.

* to be clear, I’ve phrased it this way to reflect a mindset I don’t ascribe to – being trans is no more a choice than being gay or straight, left- or right-handed, or having an allergy

Edited to correct “trans excepting radical feminists” to “trans exclusionary” – 16.36 15/1/16

I’m back!

After a difficult year, which has included a prolonged period of time off work due to injury, I am ready to resume blogging regularly. I’m not really a resolution person, so I’ll say instead that I’ll be aiming for weekly posts, with more as the spirit of rant or activism moves me. As before, my focus will primarily be on health and union issues, with politics, social justice, and the odd apparently random topic thrown in. Happy 2016!

A response to Victorian Liberals

A friend posted a link to my Facebook page yesterday, evidently from Arthur (AB) Rankin, a Victorian Liberal party member, in response to last November’s electoral win. Over nine pages of “commentary,” Mr Rankin explains why, despite “a great team… a great Leader and Premier… a great group of Ministers, a great set of policies,” “Managing the Budget responsibly and [being] on track to Achieving Financial Surpluses” they lost the election.

The TL; DR answer is teh unions (courtesy of VTH)

The TL; DR answer is teh unions (photo/caption courtesy of VTH)

It’s certainly an interesting, if long, read – in addition to the nine pages of commentary, Mr Rankin’s document includes a suppleemtary 30 pages of photos, reprints of Trades Hall material, a tweet by Billy Bragg, a couple of emails, and a four-page addenda.
It will come as no surprise to anyone that I supported and participated in the campaign…
Image by VTH, caption via Mr Rankin's commentary (that's me, uncharacteristically on the right)

Image by VTH, caption via Mr Rankin’s commentary (that’s me, uncharacteristically on the right)

Mr Rankin’s creation really does need to be read to be fully appreciated, and I know writing is almost certainly just procrastination, but one of my many weaknesses is an inability to let things drop. And while I don’t think Mr Rankin himself is so much worth responding to, it really annoyed me to hear several of the accusations made here also made by Liberal MP’s and staffers during the campaign. It made me angry then, and it turns out I’m still a little pissed.

There are three aspects I want to address. The first is the claim that campaigners were paid; the second that people impersonated nurses, midwives, teachers, fire fighters and paramedics; and the third is about unfunded hospital beds. I also have a word or two for the Liberal party.

So, a couple of points, based on my experience with the campaign.

Were campaigners paid?
I can’t speak for the staff at Trades Hall, but every other person I spoke with at each door knocking, phone banking and polling station was volunteering their time. Or were we?
– the nights I did phone banking I ate up to 3 slices of Pizza Hut pizza, on occasion washed down with soft drink, which I believe constitutes payment under Mr Abbott’s proposed workplace legislation
– I did have salad and a couple of dips at Trades Hall on election night, after several hours at a polling booth, which I suppose could be constituted as being paid
– after volunteering over 20 hours I was given/paid with a black “we are union” t-shirt
– I was given a lovely “we are union” hoodie for being the most retweeted tweeter at a pre-election rally
So I suppose I may have to concede that point, though I didn’t receive payment in any form that a bank or business would accept.

Were nurses, midwives, fire fighters and paramedics ‘ring ins’?
I can only go with my experience, which was limited to maybe a dozen phone bank sessions, a couple of door knocks, some media sessions, and an afternoon a a polling booth. In that time I had conversations with maybe fifty other volunteers, each of whom spoke about their professions in ways that seemed coherent and genuine to me.
A couple of fire fighters did mention that they weren’t allowed to wear their official uniforms off duty, so they wore modified versions.
However, in the same way I’m pretty sure my nursiness is unrelated to what I’m wearing (my workplace doesn’t even have a mandatory uniform), so to do fire fighters not stop being firies if wearing something that’s identifiably fire fight-y but not official.

Mr Rankin makes a lot of the 800 promised hospital beds, without actually acknowledging either that former Premier Baillieu promised them, or that the former Liberal government failed to deliver them.
Instead, he focuses on the fact that a sign at a polling station didn’t specify that they were hospital beds, but instead lead observers into thinking they were hospital beds because of the young nurse on the signs. Though the reference actually is to undelivered beds.

In support, Mr Rankin also cites a conversation he had on election day with a nurse who ‘revealed’ that the hospital bed she was posing beside wasn’t from an actual hospital, but from Trades Hall. A truly shocking revelation, that nobody actually stole a hospital bed that should be in use.
In any case, as I’ve discussed previously, “beds” is really short hand for “nurses/midwives to care for patients in beds” – we have the nurses and midwives (indeed, every year hundreds of graduate nurses are unable to find supported graduate nurse places, just in this state alone), we just don’t have the funding for them.
On reflection, the thing I’m most irritated by is the Liberal party’s persistent insistence on attributing electoral failure on union activism, a) as though the voice of the workers being heard is a bad thing, but the influence of employers, our most wealthy, and the IPA, is wholly appropriate, and b) without any acknowledgement that the problem may in any way be related to inhumane policies, an utter unwillingness to consider the long-term best interests and welfare of the state as a whole, and he lies of the Federal branch of the party.

My union marched with Pride

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This post was first published on the ANMF (Victoria) website, on February 6th

In 2013 I marched, for the first time, under the banner of my union, in Melbourne’s annual Pride march, honouring and celebrating lesbian, gay, bisexual, transgender, transsexual, intersex and asexual (LGBTQIA) members of our communities. I marched for my patients, colleagues, friends, and lovers who belong to these communities, and for those whose friends and families don’t or won’t support them.

Show coloursI found marching a unifying, affirming act, and a public declaration of something I hold dear – the ongoing fight by unions for the rights and equity of marginalised groups: the right to be treated fairly, without bias or discrimination, without stigma or prejudice. That’s core union business, as much as fighting for women, for migrants, for 457-visa holders to have equal pay, rights and access.

044And, I must confess, I found it gratifying to hear calls of “Here come the nurses!” “And midwives!” accompanied by cheers. It also felt good to be marching for something, in celebration, rather than against yet another attack on wages, conditions, or on those of us with least.

045So it was with considerable regret that, for family reasons, I had to be overseas during Pride, both last year and this. I thought of Pride when Sunday morning (AEST) rolled around, marching in spirit though my body was in Colorado. And I visited the ANMF (Vic branch)’s Facebook page to see their post about this year’s march.

I was a little disappointed to find, among the positive comments, a couple of posts from people who felt that
● “no workplace union should be out there marching for moral issues”
● this kind of celebration is “a bit difficult, it’s all a bit Daffyd The Only Gay In The Village, look at me look at me”.
● “perhaps members should be consulted” before staff and members marched under the union banner, because “this is still a very controversial issue”,
● “gay rights etc is not a work related issue as such,”
● “Are we going to march for every single minority out there??? Either we march for all or none” and
● we have higher priorities than supporting Pride, particularly “access to health services”

This post is not at all intended to attack people who feel this way; that’s not helpful. Instead I’m writing this post to address the issues raised by these commenters – I don’t know if they’re members, but I’m certain there are members of our union who have similar positions. As I read it these concerns come down to:
1. there is something controversial about LGTQIA rights, or campaigning for them, or about LGBTQIA people
2. members should be consulted before ANMF endorses, supports or champions something controversial
3. union business is about work related issues, and ‘gay rights’ aren’t work place concerns
4. LGBTQIA people are a minority, and if we support one minority group we should support them all
5. there are more important things to fight for

First of all, I agree (as one of them went on to say) that “Gays should be accepted as just normal people with a different sexual preference, not as a race apart” though I’d word the sentiment differently. Unfortunately, though, that’s not yet where we are, and until sexual orientation and gender identity are treated as neutrally as eye colour or arm length, there’s work to be done. I’d like to take you through some of the other concerns that were raised.

Controversy and morality
It’s true that there is controversy in some segments of Australia about any kind of ‘lifestyle’ that isn’t heteronormative (one man and one woman, in a monogamous, preferrably married, relationship) and cisgendered (people whose identity, body, and gender assigned at birth are all the same). It’s hard to know from what was posted which aspects of LGBTQIA people the commentators have an issue with – I suspect, from discussions I’ve had previously about this, that there are a few, wrapped up together.

The first is that LGBTQIA people have wilfully chosen their orientation and/or identity to be difficult, controversial or subversive. To which I say: talk to the very many survivors who spent in some cases decades hating themselves, harming themselves, and planning suicide because of truths about their core identitites that they couldn’t change, however hard they tried. One of my friends sent me his story yesterday – for years the fear of being rejected by his family and the small town he grew up in cast such a deep shadow over his life that he was so deeply depressed he planned a one way trip, the only way Al could see to escape his “pain and torment.” It was chance and wonderous good luck that he was shown another path, to realisation of his potential, a man “full of fight and compassion and living a life of service, supporting and caring for others.” This is a reality for many people, especially young people, who feel different from the mainstream, and it’s not about who they are, it’s about not being accepted by those who should most love them.

The second, as illustrated by the Daffyd comment, is that marches like Pride are showboaty, prideful, and unnecessary. ‘Why,”some people wonder, ‘can’t they just get on with life like the rest of us?’ I would say for three reasons – the first is that, after years of hiding who you are, concealing key parts of who you are from family, friends, colleagues, community, there is joyous liberation in being able to say who you are, aloud, in public, and have it be celebrated. The second is to show young people, like my friend, who feel as though they’re alone, that there’s a wider world out there – that there are alternatives to spending your life pretending to be someone you’re not until the pain of hiding who you are is greater than the pain of claiming it, or ending the pain. And marches give people and organisations who support diversity, and the rights of all of us to live lives as full and productive as possible, to show that there are people and groups who’ll embrace them for who they are, without judgement.

The third is because they believe marriage ought to be reserved for straight couples (in some versions this is justified as being about rearing children). There is not space here to discuss this argument, as my response would double the length of this not short piece. What I’ll say instead is that the most recent survey of Australians’ positions of marriage equality shows 72%, or just under three-quarters of all Australians, support marriage equality.

Regardless of how one views the question of the morality of non-heteronormative, cis-gendered people, it’s true there’s still some controversy. Of course, I can’t think of anything that isn’t controversial – medical marijuana, asylum seekers, vaccinations, funding public health care, climate change – and for some of them debate will continue without resolution, however long we talk and whatever evidence comes in. ANMF (Vic) also has positions on all of these, any way. If we waited we’d never act on anything.

Consultation with members
ANMF (Vic) is a union, designed to act on behalf of its members – if we don’t, we’re no longer functioning as a representative body. We’re fortunate to be a very large union, with over 71,000 members at the time of writing, and individual consultation isn’t possible, so we have substitutes – work place representatives, who may choose to attend an annual delegates meeting, and elected officials. In addition, any member may make a submission to the union, directly, through their job rep, or through an organiser.

Last year, for example, I suggested we support the campaign to legalise medical marijuana – it’s a health issue, so if affects our patients, and it’s currently an industrial issue, as some members have become ensnared between the law and parents administering marijuana oil to hospitalised children, so it falls into our purview on two counts. And it’s controversial, because the majority of evidence is annecdotal, and it involves a drug that’s surrently illegal, which is why an email was sent to members asking for their response – fewer than 1,000 members replied, overwhelmingly positively, and so we’ve added our voice.

In 2012, at the Victorian branch’s annual delegates meeting, a motion was put that ANMF (Vic) support the campaign for marriage equality. The delegates present voted overwhelmingly in support the campaign for marriage equality. The members who moved, seconded, spoke to and voted for the motion are representatives of their workplace members. On this, the question of supporting equal rights for LGTQIA people, the members have already spoken.

What constitutes union business
Unions are about collective bargaining, improving work conditions (eg OH&S, pay and benefits, career structure), and equity, so supporting populations who are discriminated against is very much union business. Much of the progress made in work place gender equality, including equal pay and paid maternity leave, has come from the work of unions.

Perhaps, more than anything else, unions are about solidarity – about us being stronger together than we are separately, that united we have power and apacity to make change that doesn’t exist if we act alone. A key part of union solidarity is that we stand up for those who need their voices amplified. That’s why, at the last members meeting of our 2011/12 EBA campaign, Lisa Fitzpatrick told us about the NUW strike at Sigma Pharmaceuticals in Rowvill, and why some of us went along to support blue collar men and women whose work is nothing like ours, and whose fight was the same.

023If we cared, and fought, only for those issues that we were directly affected by, there wouldn’t be a union movement – and so much of what we take for granted, the rights we have every day, wouldn’t exist. Why would men care about women being able to work after they were married? Or maternity leave provisions? Why would teachers care about deaths on construction sites? Why would Australian workers fight for the rights of workers in Sri Lanka? [link: http://www.sigtur.com/latest-stories/union-protest-embarrasses-ansell.html – photo, if we have one?]

Solidarity is why ANMF (Vic) staff and members marched alongside teachers, fire fighters, paramedics; why we’ve marched for asylum seekers, World Peace day, marriage equality, secure work, maintaining funding for WorkCover, and for Medicare funding. Because all of these things matter, and we are part of all of them – as my friend Benjamin says: “Solidarity means you march and support those groups who are still in many ways at the bottom of the pile socially, ecomomically, culturally and politically.”

However, even if that were not the case, this is also a health issue – stigma, persecution and discrimination are strong contributors to the high rate of depression, anxiety, suicidality and substance abuse among people who are LGBTQIA, and that makes it very much an ANMF issue. As does the fact that our members include lesbian, gay, bisexual, transgender, transsexual, queer, intersex and asexual nurses, midwives, patient attendants and students. Participating in this march shows people that it’s okay to acknowledge who you are, that you’re not alone (however much it may feel otherwise), and that you’re supported and accepted by the wider community.

Pridemarch - SeanAnd that, I hope, also addresses the question about whether we’re going to support other (or all) minority groups – if they’re discriminated against, if they have access to fewer rights, lesser conditions, then yes, we will.

What we should fight for

Late last year Victorian Trades Hall hosted a film night to thank volunteers involved in the election campaign. The film screened was Pride – it tells the true story of how a small group of London lesbian and gay men decided to support the 1984 Welsh miners’ strike:

It is a brilliant film that illustrates far more eloquently, ably and upliftingly than I just how LGBTQIA rights and union fights intersect, though the miners’ union took a year to come around to that position. Indeed, the fit is so natural, so apparently self-evident, that I was genuinely shocked it took until only thirty years ago to be embraced in the UK.

In Australia, though, some of us got there a little sooner – in 1973, five years before the first Sydney mardi gras, and 11 years before the events recounted in Pride, members of the Builders Labourers Federation working onsite at Macquarie University went on strike in support of a gay student activist who was excluded from the university because of his refusal to repress his orientation and “seek help.” I wrote about solidarity – it’s a core union value, and always has been.

It’s hard to think of many groups less likely to support a gay tertiary student than early seventies construction workers, but “It’s the principle of the thing. They shouldn’t pick on a bloke because of his sexuality.” – Bob Pringle, then-BLF President (NSW branch). Read more here) And they went out again, the next year, when Penny Short’s scholarship was withdrawn because being a lesbian made her “medically unfit.”

There are higher priorities
Finally, the concern was posted that LGBTQIA rights are outweighed by other, more direct concerns facing nurses and midwives, including cuts to health care funding, inadequated aged care services, and poorly served rural and remote communities. And it’s true that there is an increasing demand for health care services, and Mr Abbott’s attacks on Medicare certainly warrant a strong and decisive defence.

I won’t ask if the person who posted this comment fought against the privatisation of Victoria’s public aged care beds, or has campaigned to save Medicare, though I’d like to note that I have, and I’ve been proud to stand shoulder to shoulder with my union’s executive and staff while doing so. Instead I’ll point out these two things. First, like sexuality, this isn’t a binary state – we can champion more than one injustice or cause at a time. Indeed, we must – if we only focused on one issue, however worthy, we would have trouble achieving anything. And for the second I will once again cite Benjamin:
Pride - BenBeing part of any group larger than just ourselves means there will be things we don’t completely agree with – compromises for an overall win, fighting on behalf of people who are happy to reap the rewards of a campaign without participating, or agreeing to step back on one point for an intact and united front. Nobody is asking anyone else to participate in, or to personally endorse, anything they don’t agree with, and though I am a member, a long-time job rep, and a new branch councillor, I don’t speak for ANMF – in this piece, on my blog, to the media or on social media.

That said, I know I speak for ANMF (Vic) branch, for ANMF federally, and for the union movement as a whole when I say – lesbian, gay, bisexual, transgender, transsexual, queer, intersex and asexual rights are human rights, and they are most definitely a union fight, a health issue, and ANMF business.

Note: I am indebted to those friends who responded to my request for comments as I was writing this, including my anonymous friend for allowing me to use his story, Benjamin for drawing my attention to the case of Jeremy Fisher and for permission to use his words, and to Julie Wearing-Smith for both her support and for encouraging me to expand a Facebook response into a rather lengthy essay. And while I’m at it, thank you to my wonderful union.

1331 words on vaccinations – and some questions

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This post was prompted by being involved in two discussion threads about immunisation yesterday, one on FB and one on Twitter (the latter still progressing). They’re not the first, and I very much doubt they’ll be the last. I started writing this as a FB post, and when it grew, decided it would be better here – partly because of its length, partly because I wanted to insert a couple of sources, and partly because this way it may have a wider audience. If so, I hope it’s useful.

To eliminate any doubt, I am a proponent of vaccinations – I have the fluvax every winter (and the one year I didn’t, through chance not intent, I contracted H1N5), and I paid to have a pertussis vaccination because there are small children in my life. Even if I wasn’t concerned about the health and welfare of my father (who’s on immunosuppressant medications for an autoimmune disease, and who had an emergency splenectomy three years ago, so is double compromised), my infant nieces (born early and living in one of the lowest vaccination areas in the US), myself and my colleagues (daily exposed to infectious disease, sometimes undiagnosed on presentation), and my patients (transplant recipients, people with cancer, people with diabetes, people with autoimmune disease, people with HIV), I’m concerned about my community. As a tax payer I’m concerned about the massively higher cost of treating, rather than preventing, these diseases.

And as a nurse…
VaxIt’s clear that many people who oppose vaccinations do so out of fear and concern for their children’s safety, and I understand how, if you haven’t seen these rare-but-returning diseases, the threat of some nebulous something bad happening that you facilitated feels more real than childhood illnesses like chicken pox that you had and survived intact. Vague theories about herd immunity, and protecting other people’s children feel a lot less important than the safety of the child in front of you – your child.

And a lot of the components sound alarming – until you realise that formaldehyde is also made by your body, and is present in far higher quantities in everyday foods, like apples and pears.
Formadehyde - pears

“But,”I’ve been told, “that’s naturally occurring formaldehyde, not synthetic.” In some cases that may make a difference – at a molecular level (and formaldehyde’s a molecule), a molecule’s a molecule.
Formadehyde - synthetic vs natural
Or that the foetal bovine serum is a growth medium for live culture, present at miniscule levels within the attenuated virus, and that insulin used to be manufactured from porcine and bovine sources. Or that insulin today contains “glycerol, phenol, meta-cresol, zinc chloride, dibasic sodium phosphate dihydrate, sodium chloride, sodium hydroxide, hydrochloric acid” but we don’t see people refusing insulin until they have proof it’s safe. (Here’s a FDA link explaining why vaccination components are needed).

While many of us would be ashamed or embarrassed being labelled illiterate, there’s sometimes a kind of pride in being innumerate (mathematically illiterate or sub-literate), and the same, perplexingly, goes for scientific illiteracy. We can’t all understand my astrophysicist brother-in-law’s research (I certainly don’t), but fundamental scientific knowledge should be, well, fundamental – like the fact that everything’s made up of chemicals, even natural, unadulterated, organic, raw food.

 

Chemicals

Chemicals are not, as a group, dangerous, scary, undesirable, or possible to avoid. Their names can be long and complex, but they’re part of everything around us, and they are us.

The people writing this skewed information have to know that, while its true a high salt diet causes hypertension in genetically prone adults, alarmingly listing ‘sodium chloride’ as a “Toxic vaccine”ingredient, with the described effect of “Raises blood pressure and inhibits muscle contraction and growth” when it’s present in a smaller amount than is in a handful of corn flakes, is at best misleading, and almost certainly false. They certainly know that vaccinations aren’t “injected directly into the blood stream,” too – as everyone who’s ever received any vaccination knows, they’re injected into muscle, in either the upper arm, thigh or (rarely) buttock.

If their evidence of risk is robust enough to mean parents shouldn’t immunise their children against the known and real risks of infectious diseases, why muddy the waters with clear distortion, mistruth and fearmongery?

Everything we do has an element of risk. We reduce that risk as much as we can, particularly when it comes to our children – the risk of death is only 1% of infants hospitalised with botulism, but we don’t give honey to babies under 12 months (even breast-fed ones, and even organic honey, even in tiny doses) because their gut’s immune system can’t fight Clostridium, even though most honey doesn’t contain it.

It’s true that vaccinations are not without risk. They’re as safe as we can make them, but there will always be some risk to some people. When it comes to vaccinations, most of the adverse reactions are mild – redness or low-grade (treatable with paracetamol/acetaminophen) pain at the site, low-grade fever, a harmless rash – and considerably milder than the disease they’re protecting against.

In very rare cases a person may develop anaphylaxis, a life-threatening histological response that causes swelling of the airway – this occurs almost immediately, which is why there’s an observation period after receiving any vaccination, and why immunisers are trained in anaphylaxis management. The rate of anaphylaxis for the measles vaccine is 3.5-10/1,000,000. There are also risks of febrile convulsion* (generally one, with no ongoing problems) at a rate of 1 per 1,150-3,000, and possibly a rare blood disorder, thrombocytopenia (source for both stats as before).

For comparison, I wanted to provide the anaphylaxis risk of other agents, including peanuts, bee stings and ant bites, but though their incidence (and the incidence of other food allergies) is increasing, particularly in Australia and New Zealand, actual risk-per-exposure figures don’t seem to be easily sourced – te closest I found was this update from the Australasian Society of CLinical Immunology and Allergy. I suspect that’s because vaccinations are more highly scrutinised than other potential allergens; whatever the reason, though I can’t provide figures, there’s no question the reaction rates are higher for these hazards, by many times, than even the mildest response from vaccinations.

However, we already know that facts rarely sway people who have made decisions based in part, or in whole, from emotion, particularly fear. Indeed, facts can make them feel attacked, and more strongly hold on to their position. So the two-fold points of this post (at last!):

The first is for people who are concerned that the risks of vaccination outweigh the risks of preventable disease:
– why do you mistrust the opinions of the overwhelming number of experts?
– conversely, why do you place more faith in the opinions of people who have, on the face of it, less knowledge and fewer qualifications?
– what kind of evidence or argument would give you cause to reconsider?
– are you opposed to/concerned about all vaccinations, or some?
– if the latter, why them?

And for those of us in health, government and public policy:
– what strategies can we utilise to enhance listening and engage concerned parents?
– how can we more effectively educate the public about the risks of diseases, and the comparative safety of immunisation?

If you’re reading this and have an opinion, whether you fall into one of these groups (concerned or practitioner – or both!), please comment – I value information about this.

And on a far bigger level – we must, must, must increase numeracy, scientific literacy, and critical thinking across the board. People who understand the concepts underlying theories (including herd immunity and climate change), who can assess statistics, and who can detect invalid arguments and faulty premises, are better equipped to make informed decisions about all aspects of their lives, from taking out short-term, high interest loans (the topic of another rant) to deciding on vaccination.

*I had a febrile convulsion as an 18-month old, as the result of a nasty cold – children under the age of two have more trouble regulating high temperatures than adults do. I had no complications, and have never had another seizure.

Election day!

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A quick last post before I vote.
I first started this blog as a series of posts on the then-ANF’s Facebook page, as a way of maintaining morale through what none of us, mercifully, knew would be months of campaigning. The first post I found, tracking back when I started this blog, was December 9th 2011, when there were 1,086 days to go until Victoria voted – and that was all I wrote. Over time those posts became longer
For me, the way this government treated nurses and midwives during our dispute would be reason enough to vote them out – months of stalled negotiation, of saying one thing to our faces but (as a leaked Cabinet-in-confidence document revealed) plotting to remove ratios, skill mix, and introduce split shifts.
For many nurses and midwives, and certainly for me, the calibre of the current government was revealed when David Davis accused ANMF (Vic. branch) Secretary Lisa Fitzpatrick of blackmailing us into taking industrial action. We we’re at least as incensed by the slur on our respected leader as on the clear insinuation we’d all done something blackmaiÍable.
Nurse withdrew labour, for the first time in a quarter of a century, and only the third time in Victoria’s history.
Not to win. Not for huge pay increases. Just to get into Fair Work, just to force genuine negotiations, just to keep what we had.
And then they did it to fire fighters – while blocking WorkCover access for occupationally-acquired cancers.
And then to teachers.
And, after twenty-six months, paramedics still have no agreement, and no pay increase since 2011.
The premier’s changed, but the tactics haven’t – delay, denigrate (apparently Victoria’s most trusted profession is comprised of “thugs”), dirty tricks, and deceive.
Oh, there’s no money for paramedics, but there’s a massive budget for ads in every Victorian paper, distorting the ‘deal” on offer, without noting little facts, like a generous super package after 30years service having little meaning in a career with an average five year length of service.
Or removal of protected meal breaks, meaning MICA paramedics could work 14 consecutive hours, before factoring in up to an hour drive each way (with new ‘flexible workplace’ clauses) with no break. At all.
Like nurses and midwives, like fire fighters, like teachers, paramedics aren’t just campaigning for themselves and their profession – we’re all on the front line.
We all see what these cuts in numbers, services, support staff and funding mean for our ability to serve the public.
For teachers that means the long term education, employability and wellbeing of students
For paramedics, nurses and midwives, it means physical lives.
For firefighters it means the risk to their lives to save our lives, livestock, and property.
Today I’m voting Labor, because Victoria can’t afford another term of this government.
Because if this is how Victoria’s most trusted professions are treated, how do you think those with least are treated?
And because I believe that the Labor party, under Daniel Andrews, has vision for Victoria – growth, consultation, respect, direction, and integrity.
If you’re one of the 10% unsure how you’ll vote today, please think of this when you cast your ballot.
Vote however you like, but make your vote an informed one, a considered one.
And pay attention to preferences, because the Right’s complex deals have already created a politician out of 0.51% of the primary vote 14 months ago, and they’ve done it again this election.

31 days and this is just one reason I’ll be voting for Labor

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The first time I heard Opposition Leader Daniel Andrews promise to maintain Victoria’s nurse/midwife-to-patient ratios was on December 9th, 2011, outside the new Royal Children’s Hospital. He said that he admired and respected the work that nurses and midwives do, that he knew how important ratios were, and that if he were Premier when we next went to negotiations, ratios wouldn’t be on the baragaining table.

Dec 9 - RCH rally 18Opposition Leader Daniel Andrews at the Royal Children’s Hospitla Community Rally, 9/12/11

It would be another four months of unprecedented action and governmental bad faith before then-Premier Baillieu and Health Minister Davis – after pushing distraught nurses to take strike action for the first time in a quarter of a century – finally agreed to independent arbitration, protecting the ratios ANMF (Vic. branch) Secretary Lisa Fitzpatrick rightly calls our profession’s first born child. And I heard Mr Andrews make that pledge two more times.

What convinced me that his commitment was sincere – for politicians make and break promises all the time – came six months after that summer day, at our delegates conference.After making that promise again, Mr Andrews invited questions from the floor, and was asked to commit to another improvement, outside the public acute sector.

His response was measured, and clear – he would consider it, in the event he was fortunate enough to be granted office, but he had not looked at what implementing that measure would involve, and he would not make uncosted promises.

That indicates integrity to me, an impression reinforced a few months ago, when a source inside the Labor party told me Mr Andrews’ determination to act as though his promises would always have to be carried through had not won him friends in the back rooms among members who thought he should promise whatever it took to win.

ANMF - Daniel Andrews 2

Today I was delighted to be present at ANMF House, when Daniel Andrews committed not only that, under a Labor government, we won’t have to fight to keep ratios as we have in 2001, 2004, 2007 and 2011/12, but he’ll enshrine them in law – you can see his speech here.

This is more significant than most nurses and midwives realise – earlier this year the High Court found that fire fighter ratios, though contained in their EBA, were not legally enforceable, which makes vulnerable every occupation that has staff and workload provisions – think not only our ratios but classroom sizes to get an inkling of the scope.

In addition, he followed through on his signature a few weeks ago of ANMF’s 10-point plan to combat violence with a $20 million pledge to increase hospital security and prevention measures.

There is clearly more that needs to be done, including in aged and community care, but this is a real and very promising start.

And why do I think that Mr Andrews will keep his promise?

Not only because no sane person wants to risk the ire of ANMF (Vic branch)’s 70,000-strong members, but because I believe Daniel Andrews has integrity, and that he genuinely understands, appreciated and respects the roles nurses and midwives play in the health care system.

Mine were not the only wet eyes in the room when Mr Andrews promised to respect ratios, and that he appreciated and honoured the work we do – he received two spontansous standing ovations from the ANMF members present, for good reason. This is more important to us than almost anyone outside the professions can appreciate.

The current government have left paramedics without an agreement 26 months after their EBA negotiations started – they haven’t had a pay increase since 2011, and Australia’s highest trained paramedics earn some $30,000 a year less than their WA colleagues. If elected, Mr Andrews will send their dispute to Fair Work as his first act as Premier.

There are many reasons I believe an Andrews-led Labor government will be best for nurses, midwives, the public, and our state. His commitment to health, and my belief in his fidelity to his priomises, is a part of why I’ll be voting for Labor in 31 days.*
*This post was written on October 28th, but not published until November 5th

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