If you ask me about myself the first thing I’ll say is that I’m a nurse. It’s not my job, occupation or profession – it’s an intrinsic, integral part of who I am. When I leave the bedside, when I stop teaching, when I relinquish my registration and retire, I will still be a nurse.
Let me be clear – that doesn’t mean I have some arcane calling, it doesn’t mean I don’t value the significance and technical expertise of my role, and it doesn’t mean that I can be paid less. It’s not a calling, it’s a profession – it takes aptitude, certainly, but it also takes education, talent, application, hard hours, arduous conditions, ongoing and never-ending education, an ever-growing mound of new responsibilities (and paperwork, so much paperwork) without any diminution of my already full work load.
It has amazing, non-tangible rewards – I have had the privilege of making a positive difference to at least one persons’ life almost every day of my twenty-three year career. That helps compensate for the abuse, the hours, the stress, the shortened life expectancy and increased risk of cancer and chronic disease – but it doesn’t pay the rent.
A couple of months ago I wrote about my envy that Victoria’s teachers are able to make their historic EBA campaign about money in a way we couldn’t. Today I want to expand on the issues underpinning that.
There has been some discussion among nurses about the taxable status of the Continuing Professional Development allowance – a payment that is in essence a way for Mr Baillieu to pay us more than 2.5% without being seen to break his self-imposed EBA increases cap. For some, who believed the allowance was going to be tax-free (and there appears to have been genuine confusion, on the parts of ANF and VHIA, regarding this), the tax is reason enough to question whether the EBA would have passed a vote. That, perhaps, is a discussion for another time.
Despite having the most recent EBA, Victoria’s nurses are the least well paid in the nation – we are a long way from parity, and come 2016 we’ll be still further behind. This is because we’re also the only state where there are no aides performing nursing care in the acute public sector, and the only state with nurse/midwife: patient ratios across the acute public sector. We also have the highest percentage of ENs, because in the other states and territories their role has been eroded by PCAs. As Lisa said at one meeting (I think it was March 16) – we may want NSW pay but that comes with a host of conditions considerably worse than ours, including leave provisions, staffing and skill mix
We have decided, as a membership, that ratios and conditions are so much more important that pay increases that we are not prepared to compromise (let alone sacrifice) one for the other. The best (and possibly only) way to ensure we can fight for appropriate wages next time, instead of expending massive effort and resources to keep what we already have, is to make sure the 2016 negotiations are held with a government prepared to be open and even-handed. Opposition leader Daniel Andrews has repeatedly promised that ratios will not be on the table if he’s Premier when our EBA expires; that will be the first time that’s been the case since we won them in 2000.
Why have we had to choose? In no small part because much of the population ties nursing and midwifery to a vocational calling – and that means we risk losing some support if we couch any of our campaigns purely in terms of salary. The 2007 campaign slogan “Fund nursing properly – for a better state of health” was overtly about increasing nursing and midwifery numbers rather than individual pay increases, I suspect for that reason.
I believe we cause some of that ourselves, by perpetuating the entrenched image of nursing and midwifery as being primarily about caring, rather than emphasising the no less essential technical, intellectual, educational and adaptable elements that are required to be a proficient practitioner. I know I do it myself, when patients and families compliment my care – down play the work aspect and highlight the affinity I have for the profession – it’s something I’m working on, as part of my aim to increase public awareness of what we do, but unlike nursing it doesn’t come naturally. See what I did there? 😉
This perception doesn’t reflect the reality of contemporary nursing and midwifery – among many other attributes it requires intelligence, technical proficiency, manual deftness, the ability to re-prioritise in an instant, to multi-task all the time, to time manage and people manage and de-escalate, to communicate across culture and language, to be emotionally available but retain professional distance, to relinquish ego in favour of getting the best outcome for your patient, to manage stress without succumbing to mental illness or substance abuse, and to have great responsibility but little power (which is why nurses are still more likely to smoke than members of any other profession).
For some reason the move from hospital-based training to tertiary qualifications hasn’t been seen as an enhancement of professionalism but a loss of “real” nurses. This perception dishonours the significant changes in both care provision and patient profile in the intervening decades, and undermines any campaign for appropriate pay.
I know: I trained in one of the last hospital-based cohorts in the state. I wouldn’t change it – the experience was invaluable – but there’s no question we were seen as nurses first and students a poor second. On my very first day on the ward (nine weeks after entering the program) I was given the full care of four patients for eight hours. An RN administered my medications but everything else was down to me – running IV fluids, assessing cannula sites for potentially lethal inflammation or infection, delivering pressure care that prevented decubitus ulcers, enforcing chest physio to avoid pneumonia and limb movement to stop clots and contractures. I assessed vital signs and pain, and sought help when I was out of my depth.<
My patients were all bed-bound middle-aged women who’d had semi-elective hip replacements three to four weeks earlier. Not a single one would be an in-patient today – they’d be out of bed day one, home or at rehab by day three. None of them had significant comorbidities – today my average patient has at least three preexisting conditions. On my ward of 32 patients I’d be lucky to find four patients as stable and well as those women – the students I supervise have a far harder time than I had, caring for patients far less stable and much more complicated.
Some of my patients are prescribed more than thirty medications every day – separate drugs, not tablets. Some of them have antibiotics every two or three hours around the clock – fitting them in while ensuring none of them are infused too quickly, or to close to a previous dose, can be a logistical nightmare. All of my patients have vital sign assessment at least three times a day, including measurement of the level of oxygen in their blood – when I was newly registered there was one oximeter in my level-three trauma hospital, on the respiratory ward; we have six on my ward alone.
Nursing and midwifery expertise means today’s public sector cares for more patients, who are more sick, in less time, than ever before. We have fewer preventable complications (like falls, pressure sores, chest infections, deep vein thrombosis and pulmonary emboli) despite having an older, more demented, more complex and sicker population than ever before. Medical Emergency Team programs, which are reliant on nurses observing patient deterioration before the patient is compromised, means ICU admissions are shorter and more effective, as well as cheaper. MET programs were developed when someone realised that around 80% of all cardiorespiratory arrests in inpatients were on patients where nurses had earlier expressed concern but doctors had failed to act.
Health care is a team effort – we most certainly don’t do it alone. But patients are inpatients for nursing and midwifery care – if all they needed was medical attention and allied health they’d be outpatients. Hospital-in-the-home programs have stripped out those stable patients who need intravenous medications, and the HITH patient population is also steadily growing more acute. If you’re in a public hospital bed it’s because there are no alternatives. If you deteriorate, rapid intervention will come because a nurse sees the signs, and acts.
Today’s nurses and midwives will listen to your fears, readjust your pillows, and make you a cup of tea. But they will also save your life – because what we do is hard, and skilled, and informed by experience.
One of the weapons we have when we fight is that we have an enormous amount of public recognition, trust and support – that’s one of the reasons our campaigns get the publicity they do. Governments care about re-election, which is why we had petitions and write-in campaigns – if the public aren’t behind us then any campaign is going to be harder. Not impossible, but harder, because there’s the potential for support to swing against us, making negotiations that favour our log of claims decrease the government’s polling numbers.
Our task, as a profession, is to educate the public about the aspects of our work that aren’t emotional labour, to see us as nurse-led not medically subordinate, and to recognise the totality of the care we give. If they can understand that then maybe we can campaign for our own welfare as openly as our teaching colleagues are, instead of solely framing our needs as patient-focused. What’s good for nurses and midwives is good for the community – we know that, now you need to know it, too.