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 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

Nursing Under Napthine


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Many people think they know what nurses do, but there’s more than the tasks you see us perform; what you can’t see is the clinical judgement, the assessments, the constant re-prioritising of needs, so that what can seem really straightforward from the bed is more complicated on the floor. Some of that is inevitable, but some of it is made harder by a system under stress.

I’ve been a registered nurse in Melbourne’s public health system for over twenty years – it’s a job that I love, because I get to make a positive difference to people’s lives every day, often at a time when they’re afraid, in pain, or vulnerable.

Delivering health care has never been easy, but under the Baillieu/Naphine government my job has been more difficult than it needs to be. Every month our hospitals are put under more pressure to increase how quickly we process patients – to get them up to the wards from Emergency within four hours, even if that means they haven’t been adequately assessed, or may not even need admission; and to send patients home as quickly as physically possible, to community health support services that are increasingly stretched.

Those people who need treatment like intravenous antibiotics can, in some cases, now have them at home. Health Minister Davis has counted these patients towards the 800 new hospital beds that his government promised at the last election. But they’re not new beds.

Despite this increasingly demanding, difficult nature of our work, Victoria’s health care system is still productive and efficient, treating more patients without increased resources.

Instead of recognising that more acutely ill, complex patients need more nurses to care for them, the Napthine Government tried to reduce the number and experience of staff caring for the public.

In 2011/12, nurses had to fight harder than we’ve ever needed to before, to ensure our patients only get acute public health care from qualified nurses, not minimally-trained aides nominally under our supervision, and to keep nurse: patient ratios. Before nurse:patient ratios, I would try to care for eight or more complex patients on my own.

We asked for more nurses in emergency departments, to manage the increasing number of patients who need treating every day; we were told that would shorten ambulance turnaround times, and count as a paramedic efficiency gain, but a nursing cost, as though the aim isn’t to have a health care system functioning as a coordinated, effective whole.

And at a time when we need to be investing in aged care services, the Napthine Government has privatised 588 aged care beds, including a specialist facility that had a waiting list for vulnerable aged people with significant mental health concerns.

And there are another 243 aged care beds slated for sale, to private companies whose goal is profit, not people’s health and wellbeing. The burden of their care will fall increasingly on already struggling families, and on to the acute public sector.

Our nursing workforce is now middle aged, and getting older. We have new nurses keen to enter the profession, but funding for graduate year placements has been slashed by the Napthine Government – ending their careers before they’d begun. In one year alone, some 800 Victorian graduates were left with debt, and no options.

Premier Napthine and Health Minister Davis are making a lot of promises about their commitment to health. They’ve had four years to demonstrate that they value health, and the professionals who provide it.  In that time Victoria has seen unprecedented elective surgery waiting times, fewer acute care hospital beds, privatised aged care beds, emergency departments struggling to cope, a jump in violence against health providers, and too few new graduates entering the nursing profession to keep it sustainable, let alone attract prospective nurses.

I worry about the kind of health care my colleagues and I will be able to provide under a second term of this government, and I worry about the care my loved ones will receive. Because that’s the thing about the public health sector – if you’re really sick, it’s the only place you can be cared for. And, as so many of my patients have discovered, the next person needing emergency care could be any one of us.

This post was originally published here, as part of the Real Stories campaign – check out stories from other nurses, paramedics, fire fighters, teachers and other people whose ability to perform their work has been negaticely affected by the napthine government

Good nurses and midwives need the union, too


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I was contacted last week by a former colleague, close to midnight. Juan* had a disciplinary meeting in the morning, and didn’t know what his rights were – could he take someone with him? Could he lose his job? Would this affect his future employment?

Juan wasn’t a member of the union, which put me in a difficult position; I like him, I feel some obligation to him, but the rules are very clear – as a union delegate I can only advise and represent members. Once upon a time nurses and midwives could join up after an incident and, provided they paid a year’s worth of membership fees, they could be represented. But that wasn’t fair to those members who supported the union – if people only joined when they needed our services, we’d have a fraction of the resources and representative power we need. And so, many years ago, the decision was made – with very, very rare exceptions (which have to be approved by Branch Council), nurses and midwives of the Victorian branch of the Australian Nursing and Midwifery Federation can only be represented if they were members at the time of an incident.

But I felt sorry for Juan – a strong clinician who hadn’t slept in several days, whose relationship with his manager and his employer was affected, and who was asking for information that’s readily available to all employees, if they know where to find it. So I told him that yes, he was able to take a support person with him – a friend, relative or colleague, whose job wasn’t to advocate for him but to pay attention to information that he, being distressed, might miss.

And I asked him what had happened.

A patient had accused my former colleague of sexually inappropriate behaviour, a devastating charge for someone who has no sexual intent, who prides themselves on their professionalism, and who didn’t see a problem coming until he was told by the nurse in charge of the shift that the patient had made this accusation.

Juan was distressed on many fronts – by this attack on his professionalism; by his manager reporting it to her manager, who reported it to the Director of Nursing; by the involvement of Victoria police; by his fear of consequences to his employment and his registration; and by what he perceived as the irrational accusation of a patient he had gone out of his way to help, by getting sandwiches after hours (to reduce the likelihood of nausea from a non-steroidal analgesic), and sitting with the patient, comforting them as they cried, even though he was very busy.

I explained to Juan that, though it felt as though his management weren’t supporting him, they have a legal obligation to escalate this kind of accusation – it’s not the kind of thing that his manager can handle on her own. I explained that they have an obligation to protect the patient, to the public, and to the profession from inappropriate behaviour – though he may have been wholly innocent and well-intentioned, there are predators out there. And I explained that the union is the same – they represent members, but when someone’s done something wrong, the union’s aim is fairness, not to get an unsafe nurse or midwife off.

I also explained about the disciplinary process – the escalation of warnings that, except for wholly egregious behaviour, preceded termination of employment or reporting to the Board (examples of those exceptions are primarily criminal activities like assault or theft), and I explained that the hospital needs to reassure the patient that their complaint was taken seriously, and that there are consequences to prevent this happening again.

None of which, I finished, meant that management necessarily believed Juan had done anything inappropriate – he would need to wait until his morning meeting for that – but clearly the patient perceived inappropriate behaviour, and that’s not what we want.

Juan had, in fact, handled this patient less well than he could have. When the patient arrived on the ward, he greeted them with something he thought was cheery and light, but which had the potential to be misinterpreted, particularly (as in this case) by someone who was being admitted with something significant.

The patient reported nausea and pain – Juan palpated the patient’s upper abdomen, but didn’t explain why, or ask for permission. That arms across the shoulder and back rubbing that Juan meant to be comforting was interpreted as sexual, and because Juan wasn’t thinking about the patient’s discomfort, he didn’t pay attention to any signs the patient may have given.

Finally, Juan added to his notes after being informed of the patient’s report – his addition was defensive, referenced and denied the complaint, and recommended the patient be seen by psychiatry, a referral that was appropriate for this patient for other reasons, but which read as though it was related to a false accusation. His note should have been patient-centred, documenting the pain and distress the patient had, the measures he took to resolve them, and not have included Juan’s own concerns.

Juan told me he felt much more comfortable after our discussion, and was able to sleep for a couple of hours before his meeting.

He was fortunate that his manager, and her manager, saw this as a cultural and communication issue, heightened by the additional layer of difficulty many men in nursing have when acting in a care-delivery role – a topic I’d like to address at another time, because it’s important.

Juan was issued a verbal caution, which will go in his file for a year, then vanish if there are no further issues. He was already scheduled for a fortnight’s leave, and has been encouraged to do something he enjoys, that’s unrelated to work. When he returns he’ll be booked into a communications workshop his hospital runs, that includes role play and these kinds of scenarios, and he was reassured that his management team see him as an asset.

Juan was fortunate to have a supportive, understanding and experienced management team who value his work, and who saw the situation from a number of perspectives, not just the patient’s, and not just from a PR perspective.

But he had several days where he was far more distressed than he needed to be. Had he been a member, he could have rung the union the morning he was told of the accusation, and been given all the information I gave him. He would have had someone go with him to the preliminary meeting the next day, either a job rep like me, or an organiser from the union, who would have explained the process to him, and been able to reassure him that his managers were being fair and even-handed.

Juan joined the union between our conversation and his meeting. When we spoke about it afterwards he said that the nurses’ union where he did his undergraduate training, overseas, didn’t do very much, so joining seemed like a waste of money, especially as he was a good nurse, a strong clinician.

He said that this experience made it clear to him that anyone can need representation – that false accusations or misunderstandings are less common when you’re a good person and a good nurse, but that alone is not protection.

This is something I hear more often than I’d like.

Last year a colleague contacted me about an accusation from a nurse on another ward that she’d accessed a patient’s notes. Like Juan, Wai-Li* was hurt and outraged that her management team didn’t know that she wouldn’t do something like that. Like Juan, she called me the night before a disciplinary hearing; unlike Juan, she was a member of the union, and I was able to advise her.
Wai-Li had been asked by a friend to find out what was happening with her friend’s father, a patient on a ward she had previously worked on. The family spoke English as second and third languages, and they were concerned that they may have missed valuable information.
Rather than suggesting the family ask for a family meeting, or speaking to the Nurse Unit Manager, Wai-Li approached the nurse caring for the patient, and asked about her. The nurse, appropriately, said she couldn’t disclose information about the patient to a third-party, and left the nurses’ station.
When she saw my colleague still there on her return, several minutes later, on the staff side of the desk (where the patient histories were), she believed Wai-Li had accessed the notes, and reported this to her manager.
Patient confidentiality is taken very seriously – nurses and midwives have been fired, and sanctioned by state boards, here and overseas, for inappropriately accessing information of patients whose care they’re not involved in. Wai-Li was told she could be reported to the regulating authority if this accusation was found to be true.
I asked Wai-Li what she’d said to the family, and she replied that she’d said the nurse wasn’t prepared to disclose any information, so they should probably ask to speak to the treating doctors, perhaps with an interpreter.

I explained to Wai-Li, as I did to Juan, that there’s a process managers have to follow – it’s not personal, it’s professional, and feeling hurt and defensive gets in the way of hearing what the problem is. In this case, Wai-Li did act inappropriately, in that she shouldn’t have approached the nurse; the other nurse, a graduate, is to be commended for maintaining her patient’s confidentiality, and for reporting what she thought was a breach.

I was unable to attend the meeting with Wai-Li the next day, and it was too late in the evening to contact ANMF. I recommended Wai-Li write a statutory declaration, which has the same weight and consequences as testimony, explaining what had happened, including the reason why she was behind the nurses’ station (she called down to her ward to let them know she was going to be late back from her break, as she visited her friend’s mother while she was up there). I also recommended she contact her friend and ask him if he’d write a stat dec too – in his native language, if his English wasn’t sufficiently fluent. If he agreed, she could tell her managers at the meeting, and if the investigation went to the next step, that could be professionally interpreted, as supporting evidence that she hadn’t accessed information.

Fortunately Wai-Li’s own statement, and the willingness of her friend to provide supporting information, was sufficient for her managers, and the matter rested there.

In both these cases well-intentioned nurses were accused of significant charges that could have effected their employment and their registration. Both Wai-Li and Juan left seeking help until the last minute, instead of at the time they became aware of the process starting, causing unnecessary angst and distress. And in both cases they had management teams who were fair, impartial and reasonable.

I am well aware that there are other outcomes – nurses as innocent of actual wrong-doing as Juan and Wai-Li who have been accused of contributing to a patient’s death by giving extra narcotics; of stealing drugs for their own use; and of giving medications without an order. Last week, prompted by Juan’s case, I asked on social media for examples – these are just three, and one of them is only a fortnight old.

Nurses and midwives are very concerned about the legal ramifications of errors, particularly of Coroner’s cases. But a survey of Victorian branch members, looking at what topics and areas members would like more information about as part of ANMF Victoria’s e-learning portal, didn’t contain a single request about disciplinary proceedings, even though they are not only vastly more common, but also more likely to result in career consequences.

There are bad nurses and midwives out there – people who assault patients, who are drug-dependent, who are driven by motives other than altruism and professionalism. The public and the professions have to be protected from them, which is why we have laws, regulating agencies, policies, reporting processes, and alert, responsive managements.

There are also poor managers, unpopular but skilled nurses, malicious patients, and false accusations.

Anyone can make a mistake – I know that I still feel nauseated when I think of the handful of potentially life-threatening drug errors I’ve made. Anyone can be involved in a communication conflict – we know that from the rest of our lives, our relationships, and certainly from social media. Anyone can be thoughtless, let their attention drift at a pivotal moment, regardless of how responsible and essential their role is. Anyone can be the victim of a false accusation, whether genuine misunderstanding or motivated by malevolent intent.

Anyone can need representation. Even good nurses and midwives.

*identifying information, including names and specific details, has been changed

Fear or reason? We have a choice


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Federal police escorted a Melbourne man off a Tiger flight yesterday, not because he was armed, not because he triggered a security concern, not because he had some affiliation with a known suspect organisation, not because he’d been under surveillance, but because his doodles included words about terrorism.
This is what fearmongery is turning us in to.
On Thursday, 800 police raided 25 homes in Sydney and Brisbane (that’s 24 officers per building) – fortunately there was a lot of spectacle and movement, including helicopters, search lights and shouting, for the omnipresent media, who did their part with a lot of largely uncritical coverage.
The impetus for the raid was apparently a tapped phone conversation that has been construed as an intention to behead a random victim in a public place, and in no way coordinated with Prime Minister Abbott’s photo op sending Australian armed forces back to the Middle East, or a bill to extend the ‘sunset’ clause of Howard-era anti-terrorism legislation due to apply next year, used last week for the first time in nine years. Nope, just coincidental timing.
It’s unfortunate, then, that while a number of people were detained and released without charge, so far only two men have been charged, and one of those with illegal possession of ammunition. Of course, Dr Mohamed Haneef was also charged…
It may well be that some or all of these men were indeed going to behead someone, to fan an atmosphere of terror.
After all, the definition of terrorism is

1. the use of violence and threats to intimidate or coerce, especially for political purposes.
2. the state of fear and submission produced by terrorism or terrorization.
3. a terroristic method of governing or of resisting a government.


And what does it mean to terrorize?

1. to coerce or control by violence, fear, threats, etc
2. to inspire with dread; terrify


Terrorism is a real thing – it’s been used for millennia to cow populations. One of the most infamous examples is The Troubles, the three decades of sectarian violence in and about Northern Ireland that included a series of IRA terrorist attacks in London during the early 1970’s – a time I don’t remember, but when my parents and I lived there. My father’s office was in the city, and he quickly got used to bomb warnings. He tells me that, after the first alarm (not an experience a boy from Brisbane was used to) they worked around it, often not even downing tools.
My father’s response is not atypical of those in the UK, – after the July 7 bombings on 2005, there was a determined attitude of unity and perseverance with everyday life; in terms of attitude and behavioural change, the effect on everyday Londoners not directly affected by the bombs (which was almost all of them) lasted less than a fortnight.
America’s response to the biggest terrorist attack in their history was more in line with the perpetrators’ intent, in that coverage blanketed the news for weeks and, over a decade on, it’s still an emotive, divisive, distressing topic for many. But it didn’t see a de-escalation in US intervention in the Middle East, or a change in Western behaviour.
What’s my point?
While there have been plots for terrorism on Australian soil (including the Sydney Five, the Benbrika group, and the Holsworthy Barracks plotters), the last act of terrorism here was by Peter James Knight in 2001. What we’re doing works.
And yet, from the media and the attitude of our politicians, you could be forgiven for thinking that terrorists lurk around every corner, that our lives and liberty under constant threat.
People who are afraid lash out, and Australia’s been subject to the better part of a decade of orchestrated, ramping fear that plays on underlying xenophobia. We’ve seen it with every wave of immigration – from China during the Gold Rush, from Greece and Italy after the Second World War, from Vietnam in the 1970’s . And the concerns are always around difference, lack of assimilation, and changing our culture, as though what Australia is, is static.
Every other group of migrants has made us richer – cuisine, in the first instance, but also music, literature, perspective, diversity, culture, fashion, talent. Why do we think this will be different, instead of learning from the blind, misplaced prejudice of our past?
Resist the hysteria, focus on facts, reason, what’s actually happening.
Look back up at those definitions of terrorism.
And ask yourselves – in whose interest is an atmosphere of anxiety, fear and dissent? Who benefits from our focus being on defence, war, and restriction of expression and rights?
Here’s a hint – it’s not the man or woman in the street.

Why am I an active unionist?


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It will come as no surprise to anyone who knows me, follows me on Twitter, or has read any of these posts, that I’m an activist for progressive change and equity, nor that I’m an active unionist.

Today I was sent a link to this campaign, calling on the Greek government to review a decision acquiting farmers who shot 28 Bangladeshi farm hands who had the temerity to ask for six months of unpaid backpay.
After signing the petition I posted and tweeted the link, and had this conversation with @FakeTonyAbbott1, a parody account of Australia’s Liberal* Prime Minister

* for non-Australians: confusingly, the Liberal party is increasingly neo-conservative, not a Left organisation

* for non-Australians: confusingly, the Liberal party is increasingly neo-conservative, not a Left organisation

These kinds of conversations are part of what I love about social media, but it also prompted me to explain why I’m a unionist – and by that I mean not just a member, but an active, engaged part of not just my own union but the wider movement.
I joined the Victorian branch or the Australian Nursing (and Midwifery) Federation when I first registered, in September 1992, and I became a job representative at the same time. Like many members my joining was less out of strong union motivation (though I’ve been a Lefty since I was a teen, first marching for nuclear disarmament when I was fourteen or fifteen), but I was involved in every industrial campaign, and the 90’s in Victoria were a time of industrial threat and savage cuts. I wrote the then-Secretary if ANF (Vic) a fan letter when she lead us to win the world’s first nurse:patient ratios in 2000, and I closed beds in every campaign after that, as we fought to keep them.

In the early days of my union involvement we had a monthly meeting – reps, our organiser, and hospital management, including the Director of Nursing and the head of HR. It was quickly clear that members didn’t need to do anything wrong to need representation, and that I wouldn’t want every member caring for my family; I understood that the role of the union is to represent and advocate for members, but also for the profession, which means that representation doesn’t mean returning unsafe nurses to the bedside. And, from those very early days, my very clearest impression was of integrity.

I know that’s not the dominant narrative about unions, but it’s true nonetheless – and while I know it’s sadly not universal, I’ve yet to meet a union official who didn’t strike me as being committed to their members, their industry, and the common good.

I don’t come from a union family. To this day my father is virulently anti-union. And in fairness to him, I think he was a good employer – but he never seemed to understand my position, that not all employers are. My sense of social justice doesn’t come from him, and it’s not new.

The most recent Victorian nursing and midwifery EBA gave me an opportunity to be more involved than had been the case previously, in no small part because of the sheer length of the campaign, but also the integration of social media, and that it substantively kicked off when I had time off work. And the more involved I became, the clearer it became that we face common concerns – and that’s not just nurses and midwives, across wards and units, hospitals, states and territories, and nations.

At a statewide members meeting, Victorian ANMF Secretary Lisa Fitzpatrick told us about a campaign National Union of Workers members were running at Sigma in Rowville, and a group of us went to support them. It was my first experience of standing in front of a truck, of an organised and long-standing picket line, of police officers who (though not forceful) were considerably less friendly than they are with nurses, and I was struck by how similar our issues were – a fight not for new, improved conditions, but to keep those they already had – safe staffing, penalty rates, recognition of the toll shift work takes. And, as with our campaign, they were successful!

Some months later I was given the honour of participating in a program for union members co-run by Victorian Trades Hall and affiliated unions – my fortnight with the Anna Stewart Memorial Project  ASMP made it clear that this was the case for all the industries represented. I was shocked to learn just how endemic insecure work is, and just how many teachers, particularly graduates, are on contracts. And I attended the inaugural Fluro Fightback at Southern Cross station.

Spell-bound by Billy Bragg, I didn't get to take a crowd shot until after he left, but the crowd? Quite something

Spell-bound by Billy Bragg, I didn’t get to take a crowd shot until after he left, but the crowd? Quite something

A year later I was in London for a conference and saw a tweet about the London Fire Brigade Employee’s Union was campaigning against the closure of fire stations. I was free, so I went along to support them, and got to sit in on a London COuncil meeting, and once again realise that – despite geographic, polical and industrial differences – far more unites than separates us.
I’ve stood for Victorian fire fighters, too. And teachers, paramedics (I’m not just a nurse, I play one on YouTube), asylum seekers, workers and unions across the globe – online, if not in the flesh – and campaigned for marriage equality. Because inequality hurts us all.

All of which is preamble to this:
I’m an activist because injustice makes me sad, indignant, protective, outraged and filled with righteous anger – and those feel better if I act.

I’m an activist because I believe I have a duty to leave the world, even a tiny corner of it, better than I found it.

I’m a unionist because we share principles – fairness, representation, a voice for the voiceless, and a belief that what improves those who have least lifts all of us, while inequity hurts all of us.

I’m an active unionist because I believe it honours those who fought before me, were imprisoned and threatened, beaten, fined, and in some cases killed, for entitlements too many people seem to think were the result of natural justice, or kind employees, if they think about them at all; rights that they think are inviolable.

I’m an active unionist because I know that if they’re not defended, what was won can be lost; because it’s easier to keep them than to regain them.
And I’m a passionate, active unionist because there’s more need for people prepared to stand up than there’s been for decades. Workers across the world, including here, are under attack – and unions are the only organisations that will stop a movement that appears hell-bent of rolling us back to the pre-Industrial age.

Think that’s an exaggeration? Our very own government wants employees to be able to trade off entitlements, work for less than minimum wage, will actually compel unemployed youth to work for under minimum wage (and lose legal protections).

It angers, frustrates and bewilders me that more employees don’t realise the value of unions – and that so many members are apathetic and inactive. One person can make a difference, and if we’re united, there’s no stopping us:

Never doubt that a small group of committed people can change the world. Indeed, it is the only thing that ever has. ― Margaret Mead

The problem isn’t social media


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Today The Age published an article by
Henrietta Cook and Farrah Tomazin about inappropriate communications by members of the Liberal party – in this case by the treasurer, vice-president and other members of the University of Melbourne chapter of the Young Liberals.

In a series of screenshots of Facebook messages leaked to Fairfax Media, the Melbourne University Liberal Club members attack feminist and alumni Germaine Greer, take aim at homosexuality, and repeatedly demean women.
Club treasurer Stefan Eracleous describes Ms Greer as a ”lying f—ing c-m guzzling slut … and a union member”.
‘She doesn’t believe in God. No kids not married … what do you [e]xpect from a melb uni educated former socialist c—,” he wrote.

Before proceeding I do feel the need to note that ‘union member’ is clearly intended to be as much of an insult and indication of character as the rest of it, an attitude I’ve seen from the Right on Twitter, too.
As Cook and Tomazin note, this is only the latest in a series of comments that indicate sexist, homophobic and racist attitudes which have already reulted in political deaths for a number of current and aspirant Liberal politicians.
The problem for the Liberal party isn’t that

Social media is a very, very tricky game for people who haven’t been trained in media and communications

or that they haven’t been reined in.
The problem is that Young Libs say in public what their elders say behind closed doors, and that (as we’ve seen from the recent withdrawal of two Liberal candidates becasue of embarrassing, racist and sexist electronic communications) these attitudes are endemic through the party.
There are members who are reasonable, who respect diversity, who are interested in politics because they want to make the world a better place, and – even though we differ on how best to do that – I know, and respect, some of them.
But the members who achieve positions of power, both in Young Libs and in the party proper are, all too often, these kinds of immature, ultra-Right Wing, xenophobic, homophobic mysogynists.
I am progressive, and I find many of the policies of the Labor party more conservative than I’m comfortable with, let alone the neo-conservative positions being taken by today’s Liberal party and their companions in the UK, the US, Canada and Europe. I do not, however, want to see the Liberal party destroyed – we need balance, social justice tempered by fiscal reality, humane capitalism rther than an unsustainable sociality utopia.
Traditional Liberal values that place the privileged, wealthy, privately educated white male in a state of primacy are going to have to change if this party wants to have any relevance, Or retain any degree of power. And that attitude change has to come from the top.

March to Save Medicare


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The Abbott government was elected on a raft of lies and broken promises, all of which have the potential to have devastating consequences for many people, predominantly pretty much exclusively those with least to begin with. Not that it’s always easy to tell precisely what the effects are going to be, as even Mr Abbott’s Cabinet seem to be unsure, as evidenced by yesterday’s quick about-face on pursuing HECS debt after death (and The Conversation‘s retraction of how long HECS will take to pay off now course costs and interest will rise, but the payment threshold will drop).

I’ll write about some of the other ‘reforms’ being introduced next week, particularly the targeting of people on Disability Support Pensions. Like my topic for today, that tactic’s come straight from the UK Tory playbook.

In the UK the Conservative government slowly starved the NHS of funds, then turned around and said “see? It doesn’t work!” as an insidious privatising began.

Australia leaped ahead a little there – we’ve started selling off aged care facilities already, with barely a whisper of consultation, let alone publicity (and that, too, I’ll address next week). But today I want to talk about co-payments for GP visits (and allied health consultations, and radiology, and other investigations).

This government has launched a concerted attack on universal health care. It started with a rubbery statistic – that annually, we make an average of eleven GP visits a year. That sounds like a lot to most people, and when uttered hand-in-hand with insinuations and outright claims that ‘some people’ (predominantly over-anxious mums, and the isolated elderly) are going ‘too often’ makes it seem reasonable for a tokenistic disincentive to ease the strain on our struggling public system.

Only none of it was actually true. On average, Australians see a health care practitioner who bulk-bills all or a portion of the visit eleven times a year, true – GP’s comprise about half of that, with the remaining visits going to physiotherapists, occupational therapists, dieticians, speech pathologists, diabetes educators, clinical nurse practitioners, and the like.

There are undoubtedly some GP visits that are unnecessary – after the fact, because often it’s not possible to tell if the issue’s significant or not; laypeople aren’t doctors. And even if you know that what you’ve got doesn’t require medical attention, many visits are for mandatory medical certificates for time off work or school.

But, says Mr Abbott, we don’t value what we get for free – a small impost, the cost of a cup of coffee, a sandwich, a couple of middies, is enough to make malingerers stop, think, appreciate what they’re getting.

Only here’s the thing – we already pay for Medicare. There’s a specific levy for it. And while it’s true that the levy’s 1.5% (plus an additional 1% if, like me, when you earn over the threshold you choose to support universal health care instead of private insurers), and Medicare costs 9% of GDP, that’s been the case since 1997.

Oh, but Medicare’s unsustainable, and so we have to pay more toward it.

Except that (despite cutting CSIRO funding to the bone, including the agencies that take research from the lab to the market, where we can make money – an area where Australia lags sadly behind most countries) we need the money to fund an enormous medical research centre. Not now, but in the future, when the funding comes in. Because that means we won’t need to spend so much on health care…

Our health care system is robust, cost-effective, and it delivers. It’s not perfect, but its imperfections are predominantly in under-servicing rural and remote areas, under-funding aged care and mental health, inadequate preventative interventions, and too much emphasis on sexy, expensive, acute care.

Amazing NSW nurse Kerry Rodgers on QandA

Amazing NSW nurse Kerry Rodgers on QandA

Here’s the reality – if you want to cut health care costs, general practitioners are not the place to look. They are one of the most cost-effective parts of our system. Good GP’s save money, and lives – prompt action means that many acute issues can be treated before they worsen, and chronic conditions are managed before they become life-threatening.

We don’t have figures on how much a hospital bed costs per day, before medications and interventions (though we do for aged care),so I can’t say how much an outpatient treatment of cellulitis through a course of oral antibiotics compares to inpatient admission for five to seven days, with intravenous antibiotics. I can tell you that it’s easily a hundred times more, based on the cost of the drugs and administration alone.

I can tell you with certainty that giving pneumovax or Fluvax to someone at risk costs a fraction of treating them for pneumonia or the ‘flu – and that, having had both, you’re looking at weeks of time off work as well as direct health care costs. That’s bad from a productivity perspective, disastrous if you’re one of the 40% of our work force on casual or contract work.

Poorly controlled diabetes causes multiple irreversible complications that mean anything from admissions for amputation, to dialysis – we know that the best, and least expensive, way to avoid that is regular education, supervision and support, including annual eye exams, bi-annual podiatry, lab bloods, and consultations with a specialist team of endocrinologists, dieticians and diabetes educators working with the client, family and GP.

That’s just three conditions, off the top of my head. As a nation, GPs are cost-effective. For those who are already struggling to make ends meet, Mr Abbott’s ‘small impost’, Ms Bishop’s sandwich, Mr Hockey’s middies or a third of a packet of smokes is the worst kind of disincentive.

These are people who’ve never had to decide between utilities and rent; between school shoes or dinner; who’ve never wept at a parking fine or rent increase. If you’ve never felt your heart leap at the discovery of $5, if a bought sandwich is an everyday occurrence and not a rare treat, you don’t get to decide that $7 isn’t much.

We know what will happen as a result of this move: those who most need early intervention will delay seeing a doctor, and present at emergency departments far sicker than they need to be, which means more cost for the system, and a lot more pain, suffering, risk, and potential economic consequences for them and their families.

Those who are on disability or aged pensions and have multiple medications will reduce their doses to eke out their drugs; fewer infants and children will be immunised; Pap smear and prostate exams will fall; annual wellness checks will be skipped.

And in the short term there won’t be an effect. But it won’t take long – and I mean months – before we start seeing the real damage, in human and fiscal costs.

We know this is a government that creates policies of myopia, that is incapable of long-term or big picture thinking. And we know that it’s a lot harder to reinstate a service or good than it is to retain it in the first place.

The time to act is now. Let your MP know that you don’t support co-payments. Write to the media, ring call back radio, tweet and post and shout it.

And if you’re in Melbourne, and you’re reading this today, join thousands of health care professionals and concerned citizens as we march for Medicare!

Save Medicare

192 days, and we must invest in graduate programs


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In every developed country, the nursing workforce is aging – in Australia, over half of all nurses are aged 45 or older, and there’s a predicted critical shortfall less than a decade away.

Although this is well known, our government is not addressing the issue – though more students are being accepted into nursing degree programs (including Masters-level courses for applicants with an undergraduate degree in another discipline), funding for an intern-like graduate year has been slashed. This is a national problem, but Victoria has the highest number of placement shortfalls – last year over 800 graduates were left without a program placement (something I’ve touched on previously).

Like all degrees, nursing and midwifery are subsidised by the government – student fees only pay part of the course delivery cost. Yet, after investing tens of thousands of dollars in each graduate, the governments in every state are funding fewer graduate positions for nurses and midwives. Though not mandatory, without a graduate year it becomes increasingly difficult for inexperienced nurses to find even casual work, and it’s even harder for new midwives.

Instead of investing in local graduates, we’re filling shortfalls with 457 visa holders.

In the short-term, graduate year programs are expensive – newly-qualified nurses need supervision, including supernumerary time with a more experienced nurse, and have paid study days. Importing nurses who don’t need that investment looks economically advantageous.

And, though employment conditions are the same regardless of origin, nurses on 457 visas are less likely to know their rights and entitlements, or to take action if those rights and entitlements are curtailed – in all industries there are cases of 457 visa holders being under-paid, assigned longer hours, heavier work loads, and less leave time than they’re entitled to. There’s valid concern that any kind of protest, or even query, will see their visa revoked.

Failing to invest in our own graduates harms our profession, and our public. We cannot staff our hospitals solely with experienced local nurses supplemented by overseas-trained nurses – there aren’t enough, for a start. There will be decreasing incentive for students to study nursing or midwifery in Australia if they know that the odds of them then being able to work are lower every year. And without the equivalent of three months of full-time work, they’re ineligible to re-register, meaning every year Australia is losing hundreds of the next generation of nurses and dozens of midwives – nurses and midwives whose education we’ve already paid for.


We all benefit from the experience and perspectives of nurses and midwives from overseas, and many Australian nurses spend a few years overseas, particularly in the UK; reciprocity’s fair.

457 visas are appropriate when there’s no local skill; when it comes to nursing, midwifery, and many other industries, we have the people – we just don’t have a government prepared to invest in them.