One year ago today ANF released our public sector log of claims. As the longest EBA campaign in our history continues, with mental health nurses still fighting, ANF (Vic. branch) continues to battle on several other fronts – tomorrow our RDNS colleagues begin the next stage of their industrial action, with walk outs of up to four hours, and community rallies.

Why do RDNS nurses need the support of other nurses, midwives and the Victorian community? Because the rest of the public system rests on their backs – without robust District and commuity health nursing services, bed flow in every sector will slo. And, just like in every other sector, their clients have become more acute, and in need of more care, than ever before.

I’ve been a nurse  in Victoria’s public system, in one of Melbourne’s most acute hospitals, for over two decades. The patient population has changed significantly in that time – thanks to revolutionary improvements in health care, people are now surviving better and longer with conditions that would have killed them only a couple of decades ago. The down side of that is a rise in the average age of patients (older people are more prone to complications), and a sharp increase in the number and severity of co-morbidities (other diseases that affect their health and treatment, like diabetes), and that increases the complexity of care.

In addition, management strategies have changed. Patients who would have once stayed in bed for a fortnight after hip replacement surgery get up the following day; operations that once required significant incisions and prolonged healing times are now performed laparoscopically; conditions that would once have required six-weeks inpatient antibiotic therapy are now treated by Hospital in the Home programs, and people who would then have been admitted to ICU are now cared for on the wards. Add in the increasing need for faster bed flow and the poorly conceived idea of a four-hour target from presentation to admission (which is just not long enough to adequately assess the patient before ward transfer), and we have more, sicker people having shorter bed stays.  This all means an increase in acuity – an informal composite measure of how sick and how much care patients require, based on their current condition, their co-morbidities (, the amount of intervention required, thir mental state, and the likely trajectory of their illness.

As well as increasing the workload in hospitals, this all means a flow-on effect for the rest of the health service – less acute hospitals now have the kind of patient population major hospitals had a decade ago, while even tiny hospitals only admit patients who cannot be treated in any other way. People who would once have spent a few days in hospital are now given services that support stayng at home – and for a lot of Victorians that means the services of the Royal District Nursing Service.

Every day, RDNS staff provide professional nursing and healthcare to more than 9,500 people throughout Greater Melbourne, parts of regional Victoria, New South Wales and Auckland, New Zealand. In any given year, RDNS delivers more than 1.8 million visits to over 35,000 people, mainly in their own homes. (source)

Until 2004 Victoria’s District nurses were included in the general public Enterprise Bargaining Agreement; since then, they have maintained parity with our wages and conditions, and there has been recognition of the fact that the overwhelming majority of new District nurses come from the public sector, by including a portability of accrued entitlements clause in the Agreement – so, for example, the seven months of sick leave I’ve accrued would be transferred if I left the public system to join RDNS.

The current offer includes the removal of this recognition, which will affect the ability of RDNS to recruit from its biggest pool of potential new staff. There are also issues with the education allowance, which would see nurses of different qualification entitled to different sums despite the fact that their requirements for registration are the same. There is also a requirement that study by undertaken, then reimbursed on presentation of receipts (and, one assumed, completing a form, plus the inevitability of wait times and disagreements over what constititutes an education expense, which means the creation of a policy and ongoing review…) Critically, RDNS nurses would earn significantly less than their community health colleagues, and nurses hired after the Agreement would have different conditions from those currently in the Service.

Although RDNS members voted not to go ahead with further action, in the spirit of cooperation and concilliation, the management’s negotiating team walked away from the table, and submitted a draft unseen by ANF for ballot by RDNS staff – prompting a FairWork hearing scheduled for this evening.

After over ten months of dispute, it’s understandable that RDNS nurses may have been tempted to vote for it just to have things return to normal, but Victoria’s nurses and midwives know what they’re fighting for – the best interests of the community, the profession, and the long term welfare of the Service. So, starting tomorrow, they will utilise the same activities that resulted in success for us, their acute public sector colleagues – community rallies and rolling walk outs.

Without parity and safe conditions, RDNS will not be an attractive option for those nurses who enjoy working longterm with clients to keep them at home, monitor chronic illnesses, forestaff precentable hospital admission, provide the only human contact for the isolated, relieve pressure on hospitals and aged care facilities, and the other, countless services these nurses provide. The aging demographic of RDNS staffmeans that, as with the rest of the nursing populations globally, there is an ongoing need for enthusiastic, younger nurses. Without District nurses there is no RDNS.

Lead by a committed Executive and courageous Council, Victoria’s nurses and midwives have shown this government that we are strong, united, and determined; that’s crucial, but our most powerful tool is public support. Letters and visits to MPs, letters to main stream and local media,and calls to talkback radio all have an effect. So, too, does attendance at the rallies that became a focal point for us in December, and which start up again tomorrow, very week day from 1:30PM:

Thursday 5 July, 1.30pm – 2.30pm: RDNS Headquarters, 31 Alma Road, St Kilda
Friday 6 July, 1.30pm – 2.30pm: RDNS Yarra, 49 Sackville Street, Collingwood
Monday 9 July, 1.30pm – 2.30pm: RDNS Sunshine, 176 – 190 Furlong Road, St Albans
Tuesday 10 July, 1.30pm – 2.30pm: RDNS West Melbourne (Homeless Persons Program), 113 Rosslyn Street, West Melbourne
Wednesday 11 July, 1.30pm – 2.30pm: RDNS Caulfield, 92 Kooyong Road, Caulfield North
Thursday 12 July, 1.30pm – 2.30pm: RDNS Moreland: 106 Bakers Road, North Coburg
Friday 13 July, 1.30pm – 2.30pm: RDNS Essendon: corner Mt Alexander Road & Grice Crescent, Essendon

Sausages, balloons, community support, and an opportunity to hear the state of play, as we will hopefully be able to re-enter negotiations and reach an equitable outcome – one that allows the best nurses to provide the care and service that Victoria’s population needs and deserves.