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Australian Industrial Relations Commission Transcripts |
AUSCRIPT PTY LTD
ABN 76 082 664 220
Level 2, 16 St George's Tce, PERTH WA 6000
Tel:(08)9325 6029 Fax:(08)9325 7096
TRANSCRIPT OF PROCEEDINGS
AUSTRALIAN INDUSTRIAL
RELATIONS COMMISSION
JUSTICE MUNRO
SENIOR DEPUTY PRESIDENT O'CALLAGHAN
COMMISSIONER O'CONNOR
C2001/1910
AUSTRALIAN NURSING FEDERATION
and OTHERS
and
MINISTER FOR HEALTH (WA) and OTHERS
Consent application pursuant to section 89(7) of the Act
as an exceptional matter re a dispute pursuant to
section 99 of the Act re nurses workloads referred to
a Full Bench under section 120A of the Act
PERTH
10.10 AM, MONDAY, 8 OCTOBER 2001
Continued from 9.8.01 (on transcript)
THIS HEARING WAS CONDUCTED PARTLY BY
VIDEO CONFERENCE
PN219
MUNRO J: The hearing resumes from the date when the matter was last before the Commission. Since then I think there have been inspections conducted. There have been a number of lodgments which we will come to and some agreement about procedures. But I think perhaps the best course might be to start with whether there any changes to appearances.
PN220
MS BURKE: Your Honour, the ANF does seek the leave of the Commission to allow an amendment to the ANF appearances in this matter. We have MR ROBERT CASTIGLIONE, our legal representative, with us today. He is assisting with the case. And, therefore, we seek the leave of the Commission to allow that.
PN221
MUNRO J: Yes. Is there any objection? There is no objection. Mr Castiglione is granted leave to appear with Ms Burke. Perhaps could I just run through - I don't know that on the last occasion we marked the various documents that had been received. Perhaps you might take us through those. It might be the easiest way to do it, I think. That way we will be not missing anything. I don't know that the initial submissions were marked on the last occasion, including those from the interveners.
PN222
MS BURKE: If it pleases the Commission, what I have done is picked up from your marking of the last exhibit, which was the discussion of site inspections which was marked ANF1. And what I have prepared as far as the ANF material is concerned is a continuation of that numbering for each of the witness statements in folder 1 of the ANF submissions. And then the three alternative draft orders and the two statements in folder 2. If I could hand that up, it may assist with the proceedings.
PN223
MUNRO J: Very well, that might assist, yes. I think we did already mark - ANF1 was the submissions regarding site visits?
PN224
MS BURKE: Yes.
PN225
MUNRO J: I had, perhaps it is wrong, I am not sure whether it is. The witnesses required by ANF for cross-examination was marked as ANF2. But let's withdraw that and that need not be marked at all. I don't know that it appears on transcript that it was marked so it will displace that in order to have Mr Jones as ANF2.
PN226
PN227
MUNRO J: Ms Belinda Morieson with ANF3. Ms Lyn Tutt, ANF4. Loretta Murphy, witness statement, ANF5. Ms Peggy Briggs, witness statement, ANF6. Mr Stuart Blinman as a witness, ANF7. ANF8 is the witness statement of Mr Murdo Lee. ANF 9, the witness statement of Mr Sean Finch. ANF10, Ms Margaret Rogers, with attachment. ANF11, witness statement, Michelle Shipton, with attachment. I think I can spare myself reading these onto transcript because if a copy is provided to the court reporter she can take through to ANF23, which is the supplementary witness statement of Mr Ken Jones, with attachments.
EXHIBIT #3 WITNESS STATEMENT OF BELINDA KATE MORIESON
EXHIBIT #4 WITNESS STATEMENT OF LYNETTE TUTT
EXHIBIT #5 WITNESS STATEMENT OF LORETA VERONICA MURPHY
EXHIBIT #6 WITNESS STATEMENT OF PEGGY BRIGGS
EXHIBIT #7 WITNESS STATEMENT OF STUART BLINMAN
EXHIBIT #8 WITNESS STATEMENT OF MURDO MacKAY LEE
EXHIBIT #9 WITNESS STATEMENT SEAN FINCH
EXHIBIT #10 WITNESS STATEMENT WITH ATTACHMENT,
MARGARET ROGERS
EXHIBIT #11 WITNESS STATEMENT WITH ATTACHMENT,
MICHELLE SHIPTON
EXHIBIT #12 WITNESS STATEMENT OF RAYE McNALLY
EXHIBIT #13 WITNESS STATEMENT OF JACQUELINE FARRINGTON
EXHIBIT #14 WITNESS STATEMENT OF MICHAEL CLANCY
EXHIBIT #15 WITNESS STATEMENT OF DEREK PATERSON
EXHIBIT #16 WITNESS STATEMENT OF SALLY TOWIE
EXHIBIT #17 WITNESS STATEMENT OF LEANDA VERRIER
EXHIBIT #18 WITNESS STATEMENT OF ANNE HELENA FOYER
EXHIBIT #19 ANF ALTERNATIVE DRAFT ORDER 1
EXHIBIT #20 ANF ALTERNATIVE DRAFT ORDER 2
EXHIBIT #21 ANF ALTERNATIVE DRAFT ORDER 3
EXHIBIT #22 WITNESS STATEMENT AND ATTACHMENTS, ROBERT MAXWELL BURROWS
EXHIBIT #23 SUPPLEMENTARY WITNESS STATEMENT AND ATTACHMENTS, KENNETH BRIAN JONES
PN228
MUNRO J: Now perhaps just to identify the folders. There are ANF contentions in reply. What are they?
PN229
MS BURKE: I haven't allocated a number to those, your Honour.
PN230
MUNRO J: Those are not there yet. So the ANF outline of submissions came with the witness statement of Ken Jones. That is what you are referring to as folder 1, is it?
PN231
MS BURKE: Yes, your Honour.
PN232
PN233
PN234
MUNRO J: And they have marked after following that the draft alternative orders that I think flow through and the supplementary witness statement of Ken Jones, which is ANF23, and the rest of that document are attachments to Mr Jones, aren't they?
PN235
MS BURKE: Yes, your Honour.
PN236
MUNRO J: So that is folder 2. And there is a third document here somewhere which is the reply, is it not?
PN237
MS BURKE: Your Honour, are you referring to the ANF reply?
PN238
MUNRO J: Yes, if I can find it.
PN239
MS BURKE: I think that one was - - -
PN240
MUNRO J: You haven't marked that one, have you?
PN241
MS BURKE: - - - ANF25. It was at tab 1 in folder 2.
PN242
MUNRO J: Oh, it's the same document, is it?
PN243
MS BURKE: Yes.
PN244
MUNRO J: Perhaps I have got a second - it is ANF contentions in reply to submissions of WAGHI. There is only one of those, is there, and that was lodged on 7 September? There is no further document after that? I thought there was.
PN245
MS BURKE: No, your Honour.
PN246
MUNRO J: Perhaps it was an extra copy that came on 10 September. Yes, very well.
PN247
MS BURKE: Right. Your Honour, the only extra ones are the three alternative draft orders which have already been marked.
PN248
MUNRO J: Yes, very well. Does that complete all the lodgments by you?
PN249
MS BURKE: Yes, your Honour.
PN250
MUNRO J: Yes, thank you, Ms Burke. Perhaps, Mr Ellery, you might just take us through yours, if that is not too difficult.
PN251
MR ELLERY: Yes, your Honour. Your Honour, on 30 July we filed two folders, folder 1 and folder 2, which contained, firstly, an outline of submissions and then some 20 witness statements with attachments. It is probably - for convenience, you could look at the index which at the start of folder 1. That lists all of those documents that are filed in both of those folders.
PN252
MUNRO J: Well, we might - and then you substituted some drafts, did you? I think I have got the final drafts dated 4 October.
PN253
MR ELLERY: Correct, your Honour.
PN254
PN255
PN256
MUNRO J: And there is an outline of submissions in reply. Is that - - -
PN257
PN258
PN259
MR ELLERY: And that will be all our documents for this purpose, your Honour.
PN260
MUNRO J: Very well. Well, the Miscellaneous Workers Union, I think - their document wasn't filed. Mr Walker?
PN261
MR WALKER: Well, your Honour, they were filed on 8 August.
PN262
PN263
PN264
PN265
PN266
MUNRO J: And I think that disposes of the housekeeping other than perhaps - I think we can scrap the exhibit about witnesses required for ANF cross-examination although we have taken it to heart and will rely upon it if we need to. There is an agreed procedure, I think, as to the ANF commencing with an opening. We have reserved from 11 o'clock to 12 o'clock. We will need to rise 10 minutes beforehand so as that you can file down into the courtroom 4. There is a strict limit of 1 hour to that arrangement because the hearing room in Melbourne is required for some other purpose. I understand that there is an issue about Mr Burrows being available for cross-examination. Has that been resolved?
PN267
MS BURKE: Your Honour, I got in touch with Mr Burrows over the weekend and he indicated to me that he would be available and will attend in Melbourne this morning or this afternoon Melbourne time if he can be fitted into the 1 hour. If he can't and Mr Ellery's cross-examination requires longer, then he will be available on Wednesday morning.
PN268
MUNRO J: I see.
PN269
MS BURKE: So we would seek the assistance of the Commission to facilitate his availability by video conference on Wednesday if necessary. I suppose it depends on how long Mr Ellery will require.
PN270
MUNRO J: Well, we would, I think, make two points. If the cross-examination can be accommodated within the hour, that would be the optimal outcome of both Ms Morieson and Mr Burrows. We know or notice that Mr Burrows' evidence was the subject of comment in the WAGHI reply contentions. Perhaps that can be achieved with some economy. If not, with some reluctance, we will find another video conference time. Essentially, we do so because of the difficulty, as we understand it not only of getting to Perth but getting back from Perth at present, unless that has changed.
PN271
MS BURKE: Thank you, your Honour. We appreciate the assistance of the Commission. With the airline difficulties it has been impossible to arrange their appearance.
PN272
MUNRO J: As to whether or not there is time available, that is not a matter that I can assess at this stage but my Associate will inquire. We will see how we go between 11 and 12 here.
PN273
MS BURKE: Thank you, your Honour.
PN274
MUNRO J: In relation to Ms Briggs, if the parties reach agreement, so be it. If not, depending on how much time is going to need to be allocated to submissions at the next hearings, then that may be a problem with which the ANF who has presented the witness would have to cope. We have issued the directions. The evidence is to be taken this week and if the witness is not available, then they are not available.
PN275
MS BURKE: Yes, we understand that, your Honour, thank you.
PN276
MUNRO J: Procedures have been agreed. HSOA and WAGHI, I think, have arrangements whereby they will speak to their submissions in the closing phase which, I think, is more a matter of advising that their request has got no difficulties as far as the Bench is concerned. Have we covered all the housekeeping matters?
PN277
MR ELLERY: Your Honour, there is probably one or two I need to address. Firstly, as we alluded in one of our letters, and I know there were numerous letters in the weeks leading up to today, Alex Kirkwood who gave a statement and who the ANF seek to cross-examine, is not available.
PN278
MS BURKE: Charles Spadaro.
PN279
MS BURKE: Sorry, Mr Charles Spadaro, I am sorry, gave a statement and is not available this week. Unfortunately he is overseas. Alex Kirkwood who is his - effectively his superior in the pecking order, if you like, and is able to testify to all the facts that Mr Spadaro had testified to in his statement, is available and will be prepared to give a statement. Essentially simply confirming what Mr Spadaro's statement provided. So I simply put that on record at the outset and I haven't - - -
PN280
MUNRO J: Yes. That is acceptable course, I would think.
PN281
MR ELLERY: Yes, thank you, your Honour. And the other thing just to mention is that one of our witnesses, who is going to be cross-examined, Ms Mentell, is with us in court. She is one of our principal instructors and I did intend to have her present in court during the proceedings for the purpose of providing me with instructions. In light of the nature of her evidence and the nature of the fact that evidence has been given by our written witness statements already, I didn't anticipate any difficulties with that but obviously if the Commission has other views or if the other parties have other views, then we will need to deal with that.
PN282
MUNRO J: Is there any objection from the Bar table?
PN283
MS BURKE: Your Honour, the ANF does not have an objection. However, we would like to note that one of our principal witnesses, Mr Ken Jones, is also in the court with us and we would seek to allow him to be here too.
PN284
MUNRO J: We have no difficulty with that course.
PN285
MR ELLERY: Thank you, your Honour. That is all the matters I needed to raise at this point.
PN286
MR WALKER: Your Honour, I was just going to raise the question of the inspections and whether there would be a report for those parties who were unable to attend the inspections.
PN287
MUNRO J: Yes, thank you, Mr Walker. I had overlooked that. I was going to come back to it. My understanding is that the parties have agreed to submit notes about the broad outcome of the inspections. Whether that was to be done during the course of evidence or as part of the submissions, I am not entirely clear.
PN288
MS BURKE: Your Honour, perhaps I can assist there.
PN289
MUNRO J: Yes.
PN290
MS BURKE: On the inspections, a short document was provided to each of the members of the inspecting party for them to make their own notes on the observations as they inspected the three different hospitals. And we took note of the directions from the Commission that the site inspections weren't to be for the purposes of evidence but were to provide a context to the members of the Bench who attended them so that they would get an idea and an overview of what the hospital system is like.
PN291
MUNRO J: Yes. Would it be practicable for a copy of that note that was supplied to be duplicated or we can run one off, I suppose? Is there only note or a note for each of the hospitals?
PN292
MS BURKE: A note for each member of the inspection party.
PN293
MUNRO J: And about each of the hospitals inspected?
PN294
MS BURKE: Yes.
PN295
MUNRO J: Or is it one comprehensive note for all of them?
PN296
MS BURKE: No, it was each person had a note and made their own notes on it.
PN297
MUNRO J: I see.
PN298
MS BURKE: It could be possible to collect those. I know I certainly have ours available.
PN299
MUNRO J: Yes. Well, perhaps if you have got a clean copy, that could be prepared and presented as an exhibit somewhere.
PN300
MS BURKE: I don't have one with me today, your Honour, but I can make it available tomorrow.
PN301
MUNRO J: Yes, that is all right. And to the other - or to the interveners as well generally.
PN302
MS BURKE: Yes, certainly.
PN303
MUNRO J: All done. Ms Burke, I think the ball is in your court.
PN304
MS BURKE: Thank you, your Honour. Just in terms of the order of the witnesses, we do have - just to finish off on the housekeeping, Mr Ellery informed me that he no longer required Mr Lee and Ms Rodgers for cross-examination and so we will take those off the list. They were on the list for tomorrow's hearings. And he did indicate that if possible, we could have some witnesses on stand-by for this afternoon. And we have been seeing if we can attempt to get Ms Lyn Tutt here this afternoon, time permitting. So we will make every endeavour to make that happen.
PN305
And what I would like to do is before we actually move to the presentation of those witnesses, just to present a brief opening submission about the ANFs case, what it is we are seeking in this joint application, and to provide some information to the Full Bench about where we anticipate this case to go. So I won't launch into that unless there are any other issues at this stage.
PN306
MUNRO J: Could I ask though, that were you in a position to do so as far as practicable, we be given advance notice of the order of witnesses. I speak only for myself but it becomes almost impossible with these cases to follow the evidence if we don't have at least a day's notice. I haven't read the entirety of the material but if you give us warning, then at least overnight can be applied to familiarising oneself with the content of the witness statement.
PN307
MS BURKE: Thank you, your Honour. The order is the same as was presented.
PN308
MUNRO J: Yes. Well I note that it's Ms Morieson, Mr Jones.
PN309
MS BURKE: Yes, today.
PN310
MUNRO J: Yes.
PN311
MS BURKE: Thank you. If it pleases the Commission, this application is a joint application by the ANF and the Government Health Industry this is seeking to deal with the workload of nurses employed pursuant to the Nurses (ANF WA Public Sector) Award 1994 in hospitals and health services in Western Australia which are operated by the employer applicants. Now, that a joint application for the workload matter has been submitted, it clearly demonstrates that there is some common ground between the parties that a workload problem exists. The ANF initially raised the workload concerns of its members with the employers in October 12 months ago when it commenced negotiations for a new enterprise bargaining agreement and a full history of the background to the application can be found in Mr Ken Jones' first statement at paragraphs 20 to 59.
PN312
It is important to note though that there has been no agreement on any mechanism to deal with the workload issue despite the ANFs attempts to have discussions or meetings with the employers and there has been no acknowledgment of the workload issue in the recently certified Nurses WA Government Health Services Agreement 2001 so the issue is outstanding. Nurses did agree to follow a recommendation of the Commission that their workload concerns be brought to a Full Bench of the Commission in the form of an application for an exceptional matters order and that recommendation was issued on 5 May 2001.
PN313
And, it was on the basis that provided there is no industrial action the parties will jointly make application to the Commission to resolve the industrial dispute in relation to nurses workloads as an exceptional matter under Section 89A(7) of the Act. And these applications will be made by the close of business on Tuesday, 8 May 2001. So on 8 May, that joint application was made and the matter came before the Full Bench of the Commission.
PN314
Since the date of the application, the ANF has continued to try and seek meetings with the employers through the enterprise bargaining negotiations and even during these proceedings, once they had been listed, to try and reach an agreement on an effective mechanism to deal with the workload problem. As yet there is no agreement and the employers have continually rejected our requests for discussions.
PN315
Now, the ANF contends that the workload problem has been one of the main reasons why nurses are leaving nursing and that a solution must be found in the form of a workload management mechanism that has meaning and that is applicable for nurses at the ward level. We contend that an effective workload management mechanism will assist in the attraction and retention of nurses to the WA Government Health Industry, as has recently been demonstrated in Victoria.
PN316
I would just like to talk a little bit about how the workload problem manifests itself at the work place. Nurses do have what we consider to be an excessive patient load. This workload sometimes compromises their duty of care to their patients and presents them with Occupational Safety and Health risks. Effectively, nurses who remain in nurses [sic] are choosing either to manage their workload concerns by simply coping, or alternatively, leaving the profession, or working through agencies or as casuals.
PN317
The inadequate staffing levels mean that nursing is progressively becoming frenetic, physically hard and heavy work, in an environment where nurses have little control over their workload. There has been an increase in the acuity of patients, there's been an increase in agency and casual staff usage. Nurses don't have the opportunity to take reasonable breaks during the shift, in some cases, even comfort breaks and, they frequently work unpaid overtime.
PN318
Certainly we see that the health sector is a fairly unsafe place to work. There are considerably higher rates of occupational injury in health than in other industries and the increased workloads, the decreasing staffing levels and inappropriate skill mixes, have led to hospitals and other health settings becoming more dangerous places to work. As a consequence, nurses are being subjected to unacceptable levels of workplace violence and aggression, for instance.
PN319
Employers often exacerbate the problem by replacing qualified, registered nurses with unskilled staff or with technology, such as lifting devices. And what we find is that manual handling relating injuries do occur, continue to occur and are directly related to workload issues. An example is the situation in the Emergency Department at Royal Perth Hospital. Mr Jones' statement informs us that nurses at the Emergency Department at Royal Perth Hospital have contacted Work Safe, using the Occupational Safety and Health mechanisms available to them, to deal with their excessive workloads because of access and egress problems as a result of trolleys with patients being banked up in the Department and also excessive workloads and the stress that those excessive workloads cause for the staff. Despite Work Safe having ordered the hospital to rectify the problems through improvement notices, those problems still exist.
PN320
Fundamental to a nurses contract of employment is the concept of duty of care. Nurses frequently feel frustrated and stressed that they are unable to deliver the care required to meet the needs of their patients and they lack control over their workloads. Consequently many nurses are complaining that the work has become totally task oriented. Many experienced nurses who are required to supervise and monitor - - -
PN321
MUNRO J: That term, "term oriented," appears a few times in the statements and intentions, what's it mean?
PN322
MS BURKE: What it means, your Honour, is that nurses are only able to provide essential care and some of the fundamental aspects of a nurses role, such as providing psycho/social comfort to a patient who has just received negative bad news from a surgeon, say, for instance, that they're about to facing their imminent death, nurses are unable to actually spend the time with that patient explaining what the surgeon has just said and what it means, the implications for them. It means that nurses aren't able to provide additional care other than simply rushing to a patient, providing the injection they may need, often it's late, they're not able to actually talk to the patients and so on. So there are - even sitting with a dying patient, often patients are left to die alone.
PN323
MUNRO J: There's another term that appears relatively frequently, "the inappropriate skill mix." To take the instance of the Royal Perth - what's it called?
PN324
MS BURKE: Emergency Department.
PN325
MUNRO J: Accident and Emergency or, what?
PN326
MS BURKE: Yes, Emergency.
PN327
MUNRO J: A and E?
PN328
MS BURKE: Yes.
PN329
MUNRO J: Who are the dramatis personae for the skill mix that you are talking of. The ANF witness statements seem to refer to it as a skill mix between experienced Registered Nurses and inexperienced. The LHMU or the Department refers to it as a mixture of Enrolled Nurses and somebody else. Leaving aside the medical practitioners, what are the paramedical, if that term is admissible, is there? There are Nurses, Registered Nurses, Enrolled Nurses, what are the other titles used in Western Australia?
PN330
MS BURKE: Well, there are also Patient Care Assistants who are unregulated workers.
PN331
MUNRO J: So they're PCAs are they?
PN332
MS BURKE: Yes, PCAs.
PN333
MUNRO J: And they're what, the equivalent of Orderlies or Nurse Orderlies?
PN334
MS BURKE: Yes.
PN335
MUNRO J: Is that a National - - -
PN336
MS BURKE: Excuse me, your Honour, Mr Olson will just answer that question.
PN337
MR OLSON: Your Honour, there's a plethora of terms have sprung up over the last 5 to 10 years. I think a term you may be familiar with is, Nursing Assistant or Assistant in Nursing and that term seems to have gone by the board and we have PCAs, Patient Care Assistants. Another term is Hospital Service Assistants and Health Care Assistants. But in terms of the qualified staff providing care in Accident and Emergency Department we would have Registered Nurses and the various levels of those Registered Nurses from the most senior to the graduates. Then we would Enrolled Nurses although I don't know of many Emergency Departments where Enrolled Nurses would be employed and that would be it.
PN338
MUNRO J: I see. And would there be any PCAs in an Accident and Emergency?
PN339
MR OLSON: There are PCAs but they perform a role of cleaning, providing meals where that may or may not be appropriate or also where it may or may not be required. Fetching equipment for the qualified staff but they don't provide any direct nursing care.
PN340
MUNRO J: No. They may take a patient though from one section to another for pathology or for radiology?
PN341
MR OLSON: They would but it would be - - -
PN342
MUNRO J: Who pushes the trolleys?
PN343
MR OLSON: They would push the trolleys and they would be escorted by a qualified nurse.
PN344
MUNRO J: And does that cover the entire spectrum then? Probably no Enrolled Nurses but they would be in other wards, PCAs, nurses and then above them the medical practitioners?
PN345
MR OLSON: I'm not sure if we would say, "above them," your Honour.
PN346
MUNRO J: Well I'm going through the classification hierarchy more or less.
PN347
MR OLSON: In that case, it would be fairly accurate.
PN348
MUNRO J: And that's the broad concepts that we're referring to in - - -
PN349
MS BURKE: Skill mix.
PN350
MUNRO J: - - - inappropriate skill mix?
PN351
MR OLSON: In inappropriate skill mix. Just to answer an earlier question that you asked, you Honour, when we're talking about an inappropriate skill mix and the difference between the Senior Registered Nurses and those not so senior, within the range that exists in Western Australia, in a place like Accident and Emergency Department, you would have within the range of qualified Registered Nurses, those that may have completed a post basic degree in Critical Care and they would be considered more senior than a Level One Registered Nurse who hadn't and certainly would be considered more senior than a Graduate Nurse.
PN352
MUNRO J: Yes, thank you.
PN353
MS BURKE: Thank you, your Honour. What we find now is that many experienced nurses who are required to supervise and monitor inexperienced nurses, for example the Graduate Nurses, are finding the amount of time onerous which is detracting from their ability to provide quality care to patients. Low levels of job satisfaction are common and increasingly nurses are concerned that they are unable to deliver appropriate care to their patients.
PN354
In fact, there is an increasing trend even now for patients to be held in emergency departments while waiting for admission to the hospital which leads in some cases to patients' exposure to pressure sores. That has been one of the outcomes. And increases the workload of those nurses who are in the emergency departments.
PN355
What we are saying, your Honour, is that in order to deal with the workload problem is necessary. In fact, the parties have agreed that an order from the Commission is necessary to ensure that this workload issue can be dealt with. The order needs to contain minimum and appropriate standards for nursing workloads. A minimum standard needs to ensure that nursing workloads don't fall to unsafe levels and provide a guide for both employers and nurses at the ward level.
PN356
Nurses need to know what that minimum standard is and those nurses who are currently registered but not working in the system need to know that a standard exists to encourage them back to work in the system. We contend that excessive workloads are not only bad for nurses but also have an impact for employers, patients and the community. The decline in the number of nurses choosing to work in the profession and the fact that nurses are choosing to follow other career pathways, is exacerbating the workload problem and it means that our patients are only receiving essential care.
PN357
The result is clear, employers can't attract sufficient nurses to fill the rosters. Patients receive essential care only and sometimes later than they should and the community suffers as a result so a vicious cycle exists. I'm conscious of time, your Honour, what time do we need to - - -
PN358
MUNRO J: I think it might be best if we move now, Ms Burke, and if you want to round up, then you can do it after we've heard from Ms Morieson and perhaps Mr Burrows.
PN359
MS BURKE: Thank you.
PN360
MUNRO J: You will need to take with you, at least, the - it's Volume 1, isn't it, I think?
PN361
MS BURKE: Yes.
PN362
MUNRO J: The witness statement of Ms Morieson appears in that. And where's Mr Burrows' statement?
PN363
MS BURKE: Mr Burrows is in folder 2, your Honour.
PN364
MUNRO J: Folder 2, is it? I see, very well. Well we will adjourn into Courtroom 4.
SHORT ADJOURNMENT [10.48am]
RESUMED [11.03am]
PN365
MUNRO J: Ms Burke I think you're presenting the evidence of Ms Morieson.
PN366
PN367
MUNRO J: Yes, thank you Ms Morieson; Ms Burke?
PN368
MS BURKE: Ms Morieson do you have a copy of your statement in front of you?---Yes. Yes I do.
PN369
Can you verify that that is an accurate copy of your statement?---Yes, it is.
PN370
Your Honour, I don't have any questions for Ms Morieson. I would like to allow the opportunity for Mr Ellery to cross-examine now.
PN371
PN372
MR ELLERY: Thank you, your Honour.
PN373
Ms Morieson could I take you to your statement at paragraphs 5 and 6. Have you seen those paragraphs?---Yes I have.
PN374
They refer to a study that the ANF, Victoria branch, had undertaken on its behalf. Is that correct?---That's correct.
PN375
And at paragraph 6 you make some comments about the findings of that study?---That's correct.
PN376
Now, can I just be clear. I take it you're familiar with the study, you've read the report in some detail?---Yes I have.
**** BELINDA KATE MORIESON XXN MR ELLERY
PN377
Okay. At paragraph 6, you say that:
PN378
The report highlighted aspects of the nursing shortage in Victoria and attributed the workload of nurses as the most pervasive reason for the shortage.
PN379
Is that your statement?---That's correct.
PN380
Now Ms Morieson, I put it to you that the report simply does not make that statement. That is false.
PN381
MUNRO J: Did you hear the question Ms Morieson?---Yes I heard the question, thank you. If you look at (i), which is the executive summary at the beginning of the report, it says there workload is the key problem.
PN382
MR ELLERY: I accept that it says workload is the key problem, I'm not disputing that, but you say workloads of nurses is the reason for the shortage. And I put it to you that the report simply does not make that finding at all. What the report does say, if I can take you to page 3 - this is not iii but 3?---Yes.
PN383
Under the heading: Workload the Key Problem, it says:
PN384
The all pervasive problem in the profession is the increase in nurses workload as a direct result of staffing shortages.
PN385
?---That's correct.
**** BELINDA KATE MORIESON XXN MR ELLERY
PN386
Yes. That's what the report finds. Do you agree with that?---No. The staffing short - what - what happened in Victoria was that as the workloads increased and working conditions became more and more untenable you've had an increased number of nurses leaving nursing and therefore you've had the shortage of nursing - you got into a downhill spiral, if you like.
PN387
Right?---When people refer to a shortage of nurses they should more correctly refer to a shortage of nurses willing to nurse.
PN388
Yes, and that's your opinion I understand. But what I'm asking you about is what the report finds. The report does not make any finding does it, that workload of nurses has caused the shortage of nurses. Is that correct?---Well, I think it's inherent in - throughout the document.
PN389
Right, so that's your interpretation of it?---Um - - -
PN390
It seems to me that you're confusing symptom with cause?---I don't think it's my ..... - sorry.
PN391
I was just saying, it seems to me that you confuse symptom with cause. Do you agree with that?
PN392
THE COMMISSION: Excuse me Melbourne, you seem to be interfering with the small desk microphone there. Somebody's pressed the button in the middle. Could you please press the button and move the microphone away from any folders you've got there.
PN393
MR ELLERY: Ms Morieson we didn't hear any of your answer.
PN394
MUNRO J: Did you hear the request about the microphone? There is a very static-y noise coming from paper shuffling, so whatever the mike is that's picking that up, it might be put away from the witness if that's possible.
**** BELINDA KATE MORIESON XXN MR ELLERY
PN395
THE WITNESS: I've only got one - - -
PN396
MUNRO J: But perhaps, Mr Ellery, you might repeat the question.
PN397
MR ELLERY: Ms Morieson, I'm putting to you that the report does not make the statement that you quoted at paragraph 6 of your statement, and that you are confusing symptom with cause?---Well I guess it's down to interpretation. I think that it's - it's a chicken and egg question, if you like. I do believe that it indicates that the increased workloads for nurses drove nurses away from nursing and therefore the shortage. The question is which comes first.
PN398
Yes. Ms Morieson, you're aware that Mr Burrows has also filed a witness statement in these proceedings?---Yes I am.
PN399
Have you read that witness statement?---I have not read that witness statement recently, I would have to say.
PN400
All right. Are you familiar with a statement he makes in it, which is that:
PN401
Between the period of 1992 and 1997 the Kennett Victorian Government made around 3000 nursing positions redundant.
PN402
?---I'm aware of that as a fact. I wasn't aware of that in his statement.
PN403
Okay. But you are aware of that as a fact?---Yeah.
PN404
Okay?---I should - I should - I - sorry, could I add, a fact in so far as the data is available in this State. There is a distinct lack of data, nursing work force data, during that period.
**** BELINDA KATE MORIESON XXN MR ELLERY
PN405
Yes. Now I suggest to you that, making 3000 positions redundant in the Victorian public health system would have contributed to a shortage of nurses. Would you agree with that?---They also closed approximately 1000 beds.
PN406
Do you agree with your proposition that 3000 nursing positions were made redundant by the Kennett Government during 1992 to 1997?---Yes. Yes, I do. But if those 3000 nurses were serving the 1000 beds that closed then it's not as - as direct as it may appear.
PN407
Ms Morieson, if I can take you to your statement at paragraph 11, you assert there that "The overall impact of the Blair decision" - and we're referring here obviously to the decision of Commissioner Blair of August 2000 - "has been to attract more nurses to the Victorian public health system." Are you familiar with that statement?---Yes I am.
PN408
Has the ANF Victorian Branch conducted any independent surveys or any other statistical analysis to support that statement?---No, but the Health Department has. I mean since, certainly - if not before the Blair decision, certainly since the Blair decision, the Department of Human Services has significantly increased its data collection. And at this point in time they would be claiming, I believe, that there were over 2650 nurses .....
PN409
Well, I'm not asking you what other people are claiming, I'm just asking you what you know, so I take it your answer is that no, that there have been no such surveys or analysis done by the ANF Victorian Branch?---No, we did do surveys. We did, in November and January and February, we haven't done any since then.
PN410
Right. I take it, as a result of the Blair decision of August 2000, there were a range of improved conditions and benefits for nurses achieved aside from ratios?---Yes there were.
**** BELINDA KATE MORIESON XXN MR ELLERY
PN411
Better pay rates?---Yes.
PN412
Is it possible that the pay rates had anything to do with any nurses returning to the nursing work force?---No. I've - I've been nursing - - -
PN413
You don't think that's possible?--- - - - myself as a clinical nurse for over 25 years and I can assure you that pay rates are not a primary matter that retains nurses at the bedside. There are three issues that nurses are consistently concerned about, under three broad headings anyway. One is workloads, that is an ability to look after the patients properly. Secondly is career structure matters. And thirdly it comes under the broad heading of education.
PN414
Was career structure addressed by the outcomes of the Blair decision?---There was certainly some career structure matters addressed. There was a working party set up to address the majority of the career structure issues and to date that working party has failed to come out with any resolutions.
PN415
Yes. Now, at paragraph 13 of your statement, you suggest that:
PN416
Victoria is leading Australia, if not the world, in terms of ability to attract nurses back into nursing.
PN417
Again, have you done any statistical analysis of nursing recruitment or retention rates in other countries of the world?---I was just in California two weeks ago. I was invited over to California because there they had legislation to introduce nurse patient ratios, but they're in the midst of determining what they should be and there were nurses there from other States in America. I've also been in contact with nursing unions from Canada, the UK and New Zealand and I also regularly read nursing journals from around the world. So in terms of English language, because I'm only mono-linguid - lingual, I - when I say around the world, I mean around the English speaking world.
**** BELINDA KATE MORIESON XXN MR ELLERY
PN418
Right, so, as I understand it, the answer to my question was, no?---Statistic - if you were talking about statistics, I don't believe there is any - anywhere that statistical evidence has been collected on a universal basis around the world. But if you're talking about evidence as produced by individual country statistics, there is published in these journals - well - it - it's there.
PN419
Thank you. In relation to the negotiations that led to the Blair decision of August 2000, when did those negotiations start?---The negotiations started in earnest I think, from memory, in August.
PN420
Right. August 2000, we're talking about?---Yes, sorry, August 2000.
PN421
And did they start because the major ANF certified agreements had come to an expiry?---The agreement didn't expire until the end of August, but in that previous agreement was an undertaking that the parties ought begin their negotiations six months before the expiry date.
PN422
Yes. So, we're referring here to the ANF certified agreements covering major public hospitals in Victoria. Is that right?---That's right.
PN423
Okay. Now you had those negotiations. You then had the Blair decision of August 2000. Do you now have in place a current certified agreement for public hospitals in Victoria?---No we do not.
PN424
Right. And is it true that between the August 2000 decision of Commissioner Blair and August of this year, Commissioner Blair convened numerous conferences and hearings and other proceedings in relation to ratios?---I don't believe many of the hearings were to do with ratios; it was - all the hearings were to do with outstanding matters or for issues of clarification around other areas.
**** BELINDA KATE MORIESON XXN MR ELLERY
PN425
But there were a number of conferences in which ratios were dealt with after the August 2000?---Yes. Yes there were.
PN426
Yes?---There were.
PN427
Yes. And then is it true that in July of this year your members commenced a campaign of industrial action?---That's correct.
PN428
That campaign commenced on 17 July. Is that correct?---I would have to take your word for that, but it was around about that time. Yes.
PN429
Okay. And the campaign involved nurses effectively closing beds in accordance with nurse patient ratios. Is that correct?---That's right. The - the issue wasn't a dispute about nurse patient ratios though. The issue was really around a dispute between the hospitals and the Government about whether or not there was adequate funding for the hospitals to employ a sufficient number of nurses to actually reach the ratios.
PN430
So clearly ratios were a relevant matter in the dispute?---The funding of ratios was a relevant matter, yes.
PN431
Yes. And that campaign of bed closures went on until some time in the middle of August. Is that right?---I - I'm sorry - I think it - yes - I think it was 9 August.
PN432
Okay. I don't need precise - - -?---..... I will take your word for it.
PN433
I am not asking for precise dates, I just want to general idea of how long it went for. It went for at least three weeks or so. Is that right?---Yeah I think that would be right.
**** BELINDA KATE MORIESON XXN MR ELLERY
PN434
And during that period there were how many beds closed, in your view?---I think by the time the dispute was resolved there was close to 1000 beds closed.
PN435
Yes. And then there was then an order of the Commission by Senior Deputy President Watson, under section 127 of the Act?---That's correct.
PN436
Requiring the action to cease. Is that right?---That's right.
PN437
Did the action cease immediately on that order being made?---Yes it did and we then went into negotiations with Senior Deputy President Watson.
PN438
Yes?---And - the agreement on that was reached on the 23 August.
PN439
The agreement you're referring to is not a certified agreement, it's a written agreement. Is that right?---That's right.
PN440
Yes. Now do you have any idea how many patients were denied beds during this period of industrial action?---No, I have no idea.
PN441
Do you care?---I think nurses always care when they have to implement industrial action. I think the view of the nurses and certainly the view of the union was that it was - if we were going to restore the Victorian public health system it would be to - that there were going to be nurses there to look after the patients. And the way to do that and been be clearly demonstrated, was by the implementation of nurse patient ratios.
PN442
Is it clear though that during that period many patients were denied beds. Is that right?---I would believe that would be a correct statement.
**** BELINDA KATE MORIESON XXN MR ELLERY
PN443
Yes. I have no further questions your Honour.
PN444
MUNRO J: Ms Morieson, you said you were recently in California. It's October, as I understand the proposal about ratios in that State the, I think, privately run hospitals or the hospitals subject to the legislation, have to implement some form of ratios by the 1 January next year?---That's correct. Well if - their situation is somewhat different from ours in that the legislation has been passed.
PN445
Yes. Has there been - - -?---And if ..... - - -
PN446
Perhaps just wait until I've finished. Has there been no - - -?---I beg your pardon.
PN447
Has there been no agreement yet, or no decision by the health authority as to what ratios they will implement?---No, the negotiations are taking place at the moment between the employers and the union. But they're unlikely to reach agreement and under the American - whether it's the American or California system I'm not certain. But the Governor of California will have the final say in determining what the ratio should be.
PN448
And that's under the legislation itself?---Yeah.
PN449
Do you have a copy of the legislation?---No I don't.
PN450
I see. The legislation at present, in that State, apparently prescribes the ratio for intensive care?---They've - they've always had some sort of regulation around intensive care, as I understand it, or for a number of years, of one to one. What they're determining now is what the ratio should be in other areas. And the union, for example, is claiming that they require a one to three ratio in the general medical surgical units. And the employers - one employer is agreeing to one to four, other employers are saying one to ten.
**** BELINDA KATE MORIESON XXN MR ELLERY
PN451
Are you sure that intensive care ratio is one to one. I thought it was not quite - - -?---Well - or was it one to - it might be one to two actually, I'm not - I'm not sure; I haven't been - no, look I'm sorry, I can't answer it.
PN452
Now, California has an existing regime and a proposed one. What other international areas of the English speaking world have some form of regulation on the subject?---The two other States in America are Maine and Massachussetts and I'm not aware of anywhere else in the world that have nurse patient ratios. What I was referring to earlier, in terms of journals around the world, is that there is a shortage of nurses willing to nurse and that in the nursing journals inevitably what is spoken about as one of the major problems, not the only problem, but certainly the major problem is workloads and a lack - apparent lack of willingness on behalf of the employers to address these concerns.
PN453
Yes; in Victoria, was there an antecedent agreement for nurse/patient ratios under earlier Government arrangements prior to the Kennett Government, for instance?---No, no. The only similar thing was in our award, which has since been removed with award simplification, which, as I understand, went into the award in the 1940s or something which said that nurses - in the benevolent homes, nurses should have 1 to 10 in the am and 1 to 15 in the night duty shift.
PN454
I see. So otherwise there was no precedent for what Commissioner Blair determined?---No.
PN455
Thank you. Is there anything arising out of that, Mr Ellery?
PN456
MR ELLERY: Nothing from me, your Honour.
PN457
MUNRO J: Did you have any re-examination, Ms Burke?
**** BELINDA KATE MORIESON XXN MR ELLERY
PN458
MS BURKE: Just one question, your Honour, if that is okay.
PN459
MUNRO J: Perhaps you might just allow SDP O'Callaghan.
PN460
SENIOR DEPUTY PRESIDENT O'CALLAGHAN: Ms Morieson, Mr Ellery asked you about your paragraph 13. I am just wondering whether you might clarify for me on what empirical basis is your statement:
PN461
There is no doubt that at this point Victoria is leading Australia if not the world in terms of ability to attract nurses back into nursing.
PN462
And then again, the statement that indicates that:
PN463
Nurses are being attracted from the private sector into the public sector.
PN464
?---The evidence in terms of the opening statement is that there is no journal in the English speaking world that I have read that is not seeing an increase in loss of nurses. As an example, we had Ireland last year where nurses went on strike because of the shortage of nurses willing to nurse, and yet if you look historically 10 years ago, Ireland was providing nurses to places such as Australia, America and other countries. In terms of - I am sorry, I have forgotten the second half of your question.
PN465
Well, the statement, paragraph 13, indicates that - and I am paraphrasing it - there is no doubt that at this point Victoria is leading Australia if not the world in the attraction of nurses from the private sector into the public sector. And I am simply seeking some indication of the empirical basis upon which that statement is founded?---Because we had had our members from the private sector - because we had private sector EBs negotiated following the public sector EB, we were unable to achieve nurse/patient ratios in any of our private sector agreements. And as a result, there has been a loss of nurses from the
**** BELINDA KATE MORIESON XXN MR ELLERY
private sector who have moved across to the going into the public sector. And in particular this has been exacerbating - exacerbated the situation in our aged care sector. But it is also nurses from the acute private hospitals, have come across to work. The rough figures - if you like at the 2600 nurses that have come back into the public system, some 15 to 1600 have come in via re-entry and refresher programs and the remainder have come from other parts of the acute and aged care sector. The thing that was of particular significance in Victoria was not only the decision affirming nurse/patient ratios but the fact that the Government then ran a very large and successful advertising campaign and also funded refresher and re-entry programs. These were programs for nurses who hadn't been practising for 5 years and in the 12 week program. And the refresher nurses did a 5 to 7 week program if, for example, they were coming from a doctor's surgery or something like that. And the data from the DA ....., that currently it is something like 15 to 1600 nurses have come through those programs.
PN466
Thank you.
PN467
PN468
MS BURKE: Ms Morieson, do you believe that the nurse/patient ratios provide an effective workload management mechanism for nurses in the Victorian public system?---Yes, I do. I am not sure what mechanisms you had in Western Australia beforehand but what we had was nurse - two systems. Either professional judgment. In other words it was suggested that the nurse in charge of the shift, if there was an empty bed, could say: I can't take a new patient because we don't have nurses to look after them. Those arguments may have been won if it was the nurse unit manager who was on duty in charge of the shift. But if it was a younger or less experienced nurse in charge of the shift, they were very often over-ridden on that basis. Or we had nurse/patient dependency systems, which all work on a basis - they are computerised systems that have a timing mechanism within them that then allocate X number of hours per patient. The problem with them was that it was no good finding out that on the shift this - you worked on the pm shift, that on yesterday's shift you were short of 10 hours of nursing care. The reason that I think
**** BELINDA KATE MORIESON RXN MS BURKE
nurse/patient ratios are successful is because its got to have the nurses rostered on. And there is flexibility in the patient ratio system. So although it might say you have one nurse to four patients, if I am in charge of a ward and there is 20 patients and I have 5 nurses, the more experienced nurse might look after 5 or 6 nurses[sic]. The new graduate might look after 2 or 3. So there is flexibility within the system and that flexibility has also allowed ..... If you go to wards now the nurses will say, you know, we haven't got our full complement today because somebody rang in sick and couldn't be replaced. But it is okay because it is only for one shift and one day. Whereas in the past, we had week after week of working short staffed and that is why we left or that is why I went agency nursing or whatever it might be.
PN469
Thank you. I don't have any more questions, your Honour.
PN470
PN471
MUNRO J: Is Mr Burrows in the vicinity because we can probably fit him in?
PN472
PN473
MUNRO J: Ms Burke.
PN474
MS BURKE: Thank you, your Honour.
PN475
Mr Burrows, do you have a copy of your statement in front of you?---Yes, I do.
PN476
And can you verify that that is your statement?---Yes, it is.
PN477
Your Honour, I don't have any questions of Mr Burrows, I would like to allow the opportunity for cross-examination by Mr Ellery.
PN478
MUNRO J: Yes. I think perhaps we just need a little bit more.
PN479
Mr Burrows, your statement was lodged with the Commission on 7 September, it's attested to on 6 September, it's 45 paragraphs and it appears to have 20 attachments?---That's correct, your Honour.
PN480
Yes, thank you. And it has been marked in these proceedings with a number that I can't recall. Yes, go ahead.
PN481
MS BURKE: ANF22.
PN482
MUNRO J: ANF22.
PN483
**** ROBERT MAXWELL BURROWS XXN MR ELLERY
PN484
MR ELLERY: Mr Burrows, were you present and did you hear the evidence of Ms Morieson before?---Yes, I was present.
PN485
Okay. If I can take you to your statement? At paragraph 8 you make the assertion that:
PN486
By July 2000 nurses were leaving in large numbers due to untenable workloads.
PN487
?---Yes.
PN488
Do you have any empirical evidence or statistical evidence to support that statement?---Again it's referred to in exhibit, The Hidden Cost of Under-staffing which you referred Ms Morieson to at - I'm not sure what the exhibit number is in your the matter. It's page 3 of - - -
PN489
MUNRO J: That's the ACIRRT study, is it?
PN490
MS BURKE: Yes.
PN491
THE WITNESS: Yes, your Honour, the ACIRRT study by J.S. Considine and John Buchanan. At page 3 of the report, the second paragraph headed: ....., the report finds that the all pervasive problem in the profession is the increase of nurses' workload as a direct result of staffing shortages. And the study found that 51 per cent of ANF members are currently working with that they regard is higher than appropriate nurse/patient ratios. And there are other tables and other references through the document. For example, on page 7 table 6: Greater Source of Stress. This was a table from memory from where nurses had to indicate just one primary source of - what they believed their greatest source of stress and not entirely their only source and 51-and-a-half per cent found inadequate nurse/patient ratios - - -
**** ROBERT MAXWELL BURROWS XXN MR ELLERY
PN492
MR ELLERY: Yes. Mr Burrows, I've got to stop you there. You're not at all addressing my question and I would ask you to refer to my question if you could. My question was, did you have or do you have any empirical statistical evidence to support the assertion you make at paragraph 8 of your statement. Could you answer that question please?---The nurses were leaving because of untenable workloads?
PN493
Yes?---Well, that's what I was trying to do.
PN494
Well, I fail to see how you were doing that?---Well, the report that was undertaken by ACIRRT in our view supports that because inadequate nurse/ patient ratio is another way of saying: inappropriate workload, they're one and the same thing. If you've got an adequate nurse/patient ratio well then you control the workloads. If a workload is too much, it's because there aren't sufficient nurses or nursing hours to manage that workload, so I was trying to answer the question in that way.
PN495
All right. Well, we will move on from that question. I think that your opinion on that is clear. You accept that 3000 nursing positions were made redundant between 1992 and 1997 in the Victorian Public Health System, is that right?---I think they said 3000 nurses much rather than 3000 positions, I just can't find it at the moment - - -
PN496
Okay. Well, if you refer to paragraph 6 of your statement?---Yes, 3000 nurses made redundant and there's a significant number of part-time nurses in the system so I wasn't - I personally wasn't suggesting 300 EFT, I was suggesting 300 - sorry, 3000, I'm sorry, 3000 nurses.
PN497
Yes?---Actual people rather than EFT. But the EFT depending on what the mix of part-time and full-time was the EFT would be less than 3000 but it was a significant number.
**** ROBERT MAXWELL BURROWS XXN MR ELLERY
PN498
Yes. And would you accept that a redundancy of a significant number of nurses in the public health system would have an effect on the workloads of those nurses left in the system?---Yes. That also was indicated by Ms Morieson. The other matter that has to be taken into account is the number of beds that were open ..... in the same system and there were wholesale bed closures during that period as well.
PN499
Thank you. At paragraph 11 of your statement you refer to, and I'm summarising so tell me if you don't think my summary is accurate, that increased acuity and increased workloads have forced nurses to resign. Now, firstly do you accept that that's a fair summary?---Yes.
PN500
Do you have any statistical or empirical evidence of that?---Only again, I believe that's supported by the survey referred to and also later by a report commissioned by the Victorian Government by Professor Margaret Bennett, as we call the Bennett Report. Her findings were similar to that contained in the ACIRRT report and also I mean, on a daily basis over recent years we have our organisers and other officers and nurses and job reps telling us these things. It's been the - there wasn't any - Premier Kennett didn't commission any surveys or data collection that we were aware of during the period in office. So there's a distinct lack of data; and also the payroll systems that were done the Health Computing Services were privatised so it's extremely difficult to get data for that period.
PN501
Yes. Now in your statement at paragraph 13 you refer to a number of facts that you say are a result of staff shortages and as I read your statement you are explaining in your statement the matters that led to the decision by Commissioner Blair of August 2000, is that right?---In paragraph 13?
PN502
Yes?---They were matters that were before Commissioner Blair and in witness statements and also submissions from the Bar table. As to whether they were the actual items that caused Commissioner Blair to form his decision, I can only speculate but I'm sure they had some influence.
**** ROBERT MAXWELL BURROWS XXN MR ELLERY
PN503
All right. Further on in your - - - ?---I'm sorry, I was going to say in relation to agency staff, for example, that I referred to in paragraph 13 you may be aware there was a specific recommendation in Commissioner Blair's - in relation to the use of agency staff, for example. It was also - parts of his decision deal with workload issues such as the provision to have four clear days off without on-call or rostered duty time.
PN504
Yes. Now, can I take you to a further paragraph in your statement, paragraph 28?---Twenty eight?
PN505
Twenty eight. Where you assert that "It had been established that prior to 31 August 2000" - I assume we're talking about there - "there were approximately" - - - ?---Yes.
PN506
Yes, 2000, is it?---Yes.
PN507
"There were approximately 1300 funded vacancies"?---Yes.
PN508
Now, I put to you that the Department - the Victorian Department and the VHIA did not accept or agree with that number at any time, did they?---No at the time when we put that forward they didn't agree or disagree. Subsequently they accepted that there were funded vacancies but they disputed the amount. That's correct.
PN509
Yes, and Commissioner - I was going to ask you, Commissioner Blair did not make any finding as to that number, did he?---No, he - in one of his subsequent decisions, I think it was 13 March, I could check if required, he did refer to the filling of pre-existing funded vacancies but he did not put a figure on it, that's correct.
PN510
Yes, okay. Now, you heard Ms Morieson's account of the industrial action that occurred through July and August of this year?---Yes.
**** ROBERT MAXWELL BURROWS XXN MR ELLERY
PN511
Do you agree with that account?---Yes, in general terms I can't recall every item that she referred to but there was certainly industrial action that occurred during that period.
PN512
Yes. Now the current position as I understand it is that there is not a current certified agreement between the major Victoria public health employers and the ANF, is that right?---We're currently drafting jointly a - what will be the basis of a multi employer certified agreement. So yes, it's not been completed.
PN513
Yes. And that drafting is effectively trying to put into place matters that at least in part came out of Commissioner Blair's decision of August 2000, is that right?---Well, it's a bit more complicated. The reason that it's taken this time is that - as you referred to earlier, there are some 30-odd subsequent decisions by Commissioner Blair, most of which were not to do with ratios, they were to do with a whole range of matters such as senior's allowance, ANS qualifications and to clarify some interpretations of the Commissioner's decision. So we haven't been in a position to filing all the documents because there were some genuine matters outstanding which the Commissioner himself referred to in his decision of 31 August. For example, there were three distinct working parties established to look at Occupational Health and Safety, one was issues in community health and one was in relation to what has been referred to as new and emerging classifications. So it wasn't possible, until these matters that have been dealt with and finalised, to actually formulate a document but that's being done as a joint process now.
PN514
Do you anticipate having a finalised agreement signed between the parties within the next 2 or 3 weeks, for example?---Our aim is to try and get a multi employer certified agreement certified prior to the end of this year. As to the stages of it, we're still meeting. We met last week and we are meeting on Wednesday over that and some other issues. As far as the content of the document I don't think the content will need to - it is a matter of drafting, really.
**** ROBERT MAXWELL BURROWS XXN MR ELLERY
PN515
So am I right in assuming then that it's now been more than a year since the Blair decision of August 2000 and you're still some time away from finalising an agreement to be certified?---It's certainly 12 months since the decision but I don't think we're - no, I don't think we're far from finalising an agreed document.
PN516
Hopefully before Christmas you say?---I - well, it's not just a matter of, as you would be aware, it's not a matter of just the document, there's then a process under the Act that has to be gone through.
PN517
Yes?---There's in excess I think of 300 public sector campuses on a State-wide basis in Victoria and all members and non-members have to be provided with access to a copy of the final agreement. So it's only a matter of - it's not going to take between now and Christmas to finalise the document, I was talking about finalising the process.
PN518
Yes. Thanks, Mr Burrows, I have nothing further.
PN519
PN520
MS BURKE: Mr Burrows, in your view has the dispute about nursing workloads in Victoria been resolved now?---Yes.
PN521
Thank you.
PN522
That's the only question I have, your Honour.
PN523
PN524
MUNRO J: The Commission will adjourn back into the non-video conference hearing.
SHORT ADJOURNMENT [11.48am]
RESUMED [11.59am]
PN525
MUNRO J: Yes, Ms Burke?
PN526
MS BURKE: Your Honour, if it pleases the Commission, I would like to take an opportunity to finish off my opening submission which will take, I estimate, not more than about half-an-hour, and then after that we would seek to call Mr Ken Jones to the witness box for cross-examination and we have, as I've mentioned earlier, we've got Lyn Tutt on stand by - she should be around at about 2 o'clock. So depending on what time the Commission wants to break and so on.
PN527
MUNRO J: I think, well for guidance we would normally break at a quarter-to-1 and resume at 2.15. We will see how we go for purposes of fitting things in and I think we would rise then normally at 4.15 - but again that's flexible within normally another 15 minutes.
PN528
MS BURKE: Thank you your Honour. So, to continue from where I left off before the video conference, the ANF and the Government have agreed that an order from the Commission is necessary to deal with the workload issue. And the ANF contends that some sort of minimum standard is required to provide a guide for employers and nurses at the ward level. An effective work load management mechanism is what the ANF is seeking out of this application. Whether this be in the form of exhibit B1, which was the original ANF draft order, or Alternative Draft Order 1 or 2, it would assist, we believe, in the attraction and retention of nurses to the public health system.
PN529
Nurses have informed us, through very extensive ANF survey of public sector nurses, that they would - that the nursing workload issue is a critical factor in resolving the nursing crisis, or the lack of nurses willing to work in the system. There is not a shortage of nurses in Western Australia. There's a shortage of nurses willing to work in nursing, and the 1999 Australian Institute of Health and Welfare figures, which form an attachment to the supplementary statement of Mr Ken Jones, tell us that there are more nurses on the register than are currently working in the system. So we know the nurses are there, but they're not working in nursing.
PN530
The issue we believe that is in dispute between the parties - and the reason that we need the assistance of the Commission - is the nature of the mechanism to address what is a mutually acknowledged problem: that of nursing workloads.
PN531
MUNRO J: When you say it's a mutually acknowledged problem and your submission makes the point a few times that there's agreement by the party that a workload problem exists, in what if any terms is there a joint statement of the problem. Your definition in your opening statement of what the workload problem is, I think, is around paragraphs 22 to 23. Have the parties at any stage come onto common ground as to what is the workload problem about which they're agreed?
PN532
MS BURKE: Your Honour, I am referring to the application that has been made and the actual wording of the application in the matter, which does specify the issue as being the workload of nurses employed, pursuant to the Nurses (ANF WA Public Sector) Award 1994 in hospitals and health services in Western Australia which are operated by the employer applicants. And I also refer to material that is submitted in Mr Ken Jones statement about the history of the matter and the role the Commission has played in that in terms of its recognition that the workload issue is one of major concern for nurses in Western Australia. However, I think the extent of the workload problem may be at issue between the parties, and how to deal with it.
PN533
MUNRO J: Perhaps it just might be noted that it's certainly a matter in which I would be interested to see what definition can be developed of the precise nature of the problem. It's obvious that there is a shortage of nurses, and that translates into staffing difficulties, both for employers and for employees. But after that, apart from agreeing as to how the matter comes before the Commission - may be buried in the material - there does need to be a transposition to identify what are perceived to be the aspects of it, for instance the working of back to back shifts too regularly. Probably both management and employees would concede that it is a symptom of a problem that's a costly one to the employer as well as for the employee. There is a high incidence of it and presumably it's measured. It would be useful to know where that measurement is.
PN534
What I am looking for is what is the common ground as to how the problem manifests itself, and is there any common ground as to what are the manifestations and the regularity of them. Your spelling out of the context of the application has some detail of what you regard as the problem, but it's equally clear that the employer contests that there's some of those facts or assertions. Yes, thank you.
PN535
MS BURKE: Thank you, your Honour. In terms of the outcome of these proceedings, your Honour, the ANF contends that any final mechanism or order must be workable in practice. A mechanism needs to be understood by nurses at the ward and unit level, so that they know what they are to do. And it also needs to have the ability to be flexible and to cope with the hospital environment, patient acuity considerations, ward layout and geography of hospitals and so far and so on. So what the ANF has presented to the Commission are a range of options to deal with the issue. And that's because we do seek a mechanism and we have presented options that will actually allow the Commission the opportunity to see various forms of solution that may be suitable.
PN536
The first one is exhibit B1 which contained what can be described as mandatory nurse to patient ratios, based on the Victorian nurse to patient ratios and based on the material that was used to develop the recommendation for legislation in California. These mandatory ratios would provide a minimum standard of nursing care, and the - probably the main merit of the mandatory ratios are the simplicity with which they can be applied. They would meet the criteria of being understood by nurses at the ward and unit level and it would also provide a guarantee or a gold standard benchmark of patient care, that could be understood by community and nurses who are thinking of - who would be considering coming back to nursing.
PN537
However, the ANF doesn't contend that that particular exhibit B1 of the mandatory nurse to patient ratios, is the only effective mechanism to address the issue of nursing workloads. In fact, when we do turn to Mr Ken Jones' evidence, we have presented in his supplementary witness statement, a range of measures that have been taken around Australia to deal with nursing workloads. And so it probably is worth having a little bit of a look at those - they include the computer software package-type arrangements such as programs known as Trend Care or Excel Care and what happens there is the information is punched into the computer and what it spits out is the number of nurses required to fill a roster. And that's the kind of thing that operates in South Australia.
PN538
We also have agreements around the country where nurses, through their unions and representatives, have agreed with employers through enterprise bargaining agreements to have bed containment initiatives such as the ACT and that's in Mr Jones' supplementary statement - again he talks about the various options that are available when safe nursing staffing levels aren't met. And perhaps if we actually take Mr Jones' supplementary statement and refer you to these various alternative mechanisms that do exist. It's in folder 2 and it's ANF 23, and in particular I am referring to paragraphs 22 to 27. And attached to Mr Jones' are the various industrial agreements that contain those mechanisms, for further information. So it's clear that the mandatory ratios as set out in exhibit B1 are only one way of dealing with it. But we do say they provide a minimum standard, a safe minimum standard.
PN539
The second option that the ANF has presented is in Alternative Draft Order 2, which is in the same folder, and if I could just turn to - sorry, I will turn to draft order 1, I beg your pardon, ANF19. Now, Alternative Draft Order 1 still presents a complete workload management mechanism. But instead of having what is in exhibit B1 a mandatory ratio, it actually has what we have described as indicative responsibility allocations. So we're not talking about a mandatory ratio in this alternative. We're talking about establishing a benchmark of patient to nurse workload responsibility allocations. So it's probably more flexible than the ratios themselves in that it can accommodate the peaks and troughs of patient acuity. It's appropriate and applicable for rural hospital activity levels, and it can inform nurses at the bedside that there are safe standards that the employer will follow.
PN540
Now, this order also contains a series of nursing staffing principles, which are absolutely fundamental to a model that does contain some flexibility. Because while the indicative responsibility allocations are, when you have a close look at them, the same nurse to patient ratio, they are flexible and not mandatory. So certain things need to be considered, such as the clinical assessment of the patient's needs, the demands of the environment such as the ward layout, safety in-house legislation, nurse regulatory legislation and professional standards and reasonable workloads.
PN541
Now, this order has regard to the employers budgetary parameters and it actually considers the funding allocation that the Government has made to the introduction of 400 new nurses. It also contains a grievance procedure. So that where those indicative responsibility allocations aren't met, there's a mechanism to actually deal with the workload concern if it's on-going or if it extends for weeks as opposed to just a short-term glitch. So Alternative Draft Order 1 actually contains what we would consider to be a flexible model but which does have some principles and a benchmark and also contains a mechanism for dealing with concerns if that benchmark is not met.
PN542
Now, if you turn to the Alternative Draft Order 2. This is another way that this matter could be resolved, which has regard to the range of different workload management mechanisms that operate around the country. And Alternative Draft Order 2 is ANF20 and immediately follows ANF Alternative Draft Order 1 in folder 2. Again, what we have introduced here is a requirement for a mechanism to be found which is based again on nursing staffing being determined with certain principles and this one actually allows the parties to properly pilot, trial and test some of the different options that exist. In fact it requires an investigation of a range of models such as the Trend Care or Excel Care option; perhaps ratios; perhaps the bed containment initiatives as apply in the ACT; perhaps the nursing hours per patient day model that the employers have included in their evidence. So that some serious discussion and consideration can be given to those, with the ultimate result being a pilot of one particular model and then implementation of the model after that.
PN543
Again, this draft order accepts and acknowledges that the employer does have certain budgetary parameters and it has consideration to the fact that money has been set aside by the Government for the introduction of 400 new nurses. Again, it contains what we think is very important, which is a grievance procedure. So that while the deliberations are carried out, a nurse who - or a group of nurses who do have a significant concern about their workload, have a mechanism to deal with it, pending the outcome of the process.
PN544
MUNRO J: Are the grievance procedures common to each of the alternatives?
PN545
MS BURKE: Yes, they are.
PN546
MUNRO J: They are in the exactly terms as WAGHI suggested they were?
PN547
MS BURKE: Yes, yes.
PN548
MUNRO J: WAGHI suggested they weren't. Yes.
PN549
MS BURKE: Now alternative draft order 3 is what we would describe as a minimal order and, unfortunately from our point of view, it leaves the quest for a suitable and effective workload management mechanism unresolved. If the Commission isn't persuaded that either exhibit B1 or alternative draft orders 1 and 2 are justified, this would be the absolute minimum order to actually deal with the concerns, because at the very least, it identifies some principles for nursing staffing. It has a grievance procedure. And it also contains elements of the Government Health Industry's proposed order in terms of reporting and meetings. So the reason that we would need an order like this is if it was found by the Commission that the more substantive alternatives are not appropriate.
PN550
Now, I would just like to mention some issues with what the Government has done and we contend that the Government actions are inadequate in terms of dealing with the nursing workload issue. The ANF contends that the first priority of WAGHI is to fill the nursing vacancies that it currently has. In fact, filling those vacancies would go in some way to alleviate the workload problem. We contend that the money that the government has set aside, if we can find through our cross-examination that the money is actually there, should be spent on an effective workload management mechanism for those nurses who are currently working in the system. It would attract nurses to work in the WA Government health industry. We propose to show in our cross-examination that the WAGHI evidence doesn't indicate any success in terms of nursing recruitment from the advertising campaigns it has run and there is no evidence that would inform the Commission of the efficacy of the initiative.
PN551
We also contend that the government commitment to refresher and re-registration courses, as outlined in the evidence of Mr Phil Della, is inadequate and, further, that the promise that the current government - that being the employers - of $12 million towards recruitment and professional development for nurses prior to the election does not appear in the evidence of Mr Della in terms of the strategy that the government will implement.
PN552
MUNRO J: In that context, where do we find what are the existing obligations or rights in relation to professional development? Are they dealt within the agreement that we certified?
PN553
MS BURKE: Your Honour, there is a commitment to some professional development leave in the newly certified agreement but perhaps if we have a look at Mr Ken Jones' statement, there is a supplementary statement I believe it is in, there is an attachment which is the State Government's election promises and - just let me find- - -
PN554
MUNRO J: Perhaps I don't need to take you to it, or get you to take me to it at present, particularly if it's a State Government election promise. What I'm interested in - perhaps this again could be dealt with at a later stage - is to contrast or is to get an understanding effectively of what are the rights and duties at different levels of the registered nursing structure to gain access to or to undertake professional development. I'm aware that, in relation to the teachers in Western Australia, there was a matter of some controversy in fact because some teachers didn't want to go to professional development courses. On the other hand, most people wanted them to go, I think the agreement deals with it and, on the limited amount of material that I've looked at, there is an assumption about professional development.
PN555
I think Mr Jones spells out what he has done himself but it's pretty hard to see it in the context as to whether there are occasional opportunities for people to go along to an hour or a two-hour session or whether they are expected to have a particular discipline refreshment each year and, if so, in what quantum and how is it provided and is there any compulsion. Yes, thank you.
PN556
MS BURKE: Thank you, your Honour. The WAGHI proposed order, your Honour, is an inadequate response to the nursing workload issue and we say that for a matter to be presented to the Commission as an exceptional matter, there must be some rationale for that greater than it just being the outcome presented in the Government's proposed order which is merely a reporting mechanism and doesn't provide any mechanism to resolve the nursing workload issue. The order extends beyond the matter identified in the initial application to include organisations that are not applicants to the matter with an approach that does undermine, in our view, the exceptional nature of the matter and really what the order represents is maintenance of the status quo.
PN557
Now, there have been some objections to all of the ANF draft orders, that being B1 and alternative draft orders 1, 2 and 3, by the employers and the ANF submits it is not interested in impairing the State's rights in relation to the identity and number of employees it seeks to employ. What we are looking for is an effective mechanism to deal with the nursing workload problem. The ANF is quite comfortable with the orders it has presented and Mr Castiglione is here with me and quite prepared to provide a brief report on the direction the ANF is taking with the re AEU issue if the Bench requires that. However, our arguments will be developed in our closing submissions.
PN558
MUNRO J: Yes; I don't think you can get out of it that way, Ms Burke. We don't require anything, it is up to you to present your case but I understand what you're saying. The matter perhaps can wait until the argument develops from the State.
PN559
MS BURKE: Okay. That concludes my opening submission and we have 15 minutes before - - -
PN560
PN561
MS BURKE: So, Mr Jones, do you have a copy of your initial statement with you?---Yes I do.
PN562
MUNRO J: Perhaps, Mr Jones, as a commencement you might just repeat your name and address for the record?---It's Kenneth Brian Jones and my address 396 Beaufort Street, Perth, Western Australia, 6000.
PN563
It is designed, Ms Burke, to avoid the unusual possibility that the name of the witness is given when swearing the oath is not the true person so they repeat their name on oath.
PN564
MS BURKE: And Mr Jones, do you have a copy of your supplementary statement in the attachments to it as well?---Yes, I do.
PN565
Okay. If it pleases the Commission, I'm not proposing to examine Mr Jones. We will move straight to the cross-examination.
PN566
MUNRO J: Very well, Mr Jones, just to identify that statement, we have marked it as exhibit ANF2 and there's another one which is the supplementary statement which we have marked as ANF23 and your statement was, I think, some 108 paragraphs attested to on the 13 July, with attachments I think that run through to KBJ14 and the supplementary statement was attested to on 6 September 2001, that's 37 paragraphs with, I think, supplement exhibits through to KBJ supplement 20?---Yes, that's right, your Honour.
PN567
MUNRO J: Yes. Mr Ellery?
PN568
MR ELLERY: Thanks. Mr Jones, if you could turn to your first statement, paragraph 21, do you have that?---Yes.
**** KENNETH BRIAN JONES XXN MR ELLERY
PN569
That paragraph, in broad terms, refers to a survey that the ANF undertook, is that right?---Yes.
PN570
Were you directly involved in organising for that survey to occur?---No I wasn't.
PN571
Do you know of whether the survey company that it's referred to - sorry, that's the company that carried out the survey - do you know whether there was any selection process to choose that company over another company?---I'm not aware of the selection process.
PN572
You're not aware, okay. Are you aware of how the survey was distributed to nurses or to ANF members?---Broadly, yes, broadly.
PN573
What can you tell us about that?---What I can tell about that is the questionnaire, once it was finalised, was sent to the membership of the Federation that work in the public health system, with specific feed-back time frame.
PN574
Do you know how it was sent to the membership?---I understand it was both distributed to, in some work sites to individual nurses and by post or mail to other individuals and that would have been with the assistance of such personnel as our site job representatives.
PN575
Was the survey offered or distributed to nurses who are not members of the ANF?---Nurses that were non-members, they could access the survey.
PN576
How could they access it?---No, sorry, I will withdraw that. I meant the results were available. No, the actual survey - the actual survey I believe was only accessible to members.
**** KENNETH BRIAN JONES XXN MR ELLERY
PN577
To members. So, am I clear, only members were able to actually complete the survey, is that what you mean?---That's my understanding.
PN578
Right. Are you aware of what levels of membership the ANF holds in WA public hospitals?---Yes I am.
PN579
And can you tell us what they are?---We have approximately 8000 members within the State and approximately 60 per cent of those are public sector nurses.
PN580
MUNRO J: Sorry, how many, 60 per cent public sector.
PN581
MR ELLERY: Which, on my not very reliable mathematics, is about 4800. Is that right?---Yes that would be right.
PN582
Do you know how many nurses actually work in the WA public sector - sorry, how many registered nurses work in the WA public sector?---We have about 10,000 individual nurses that make up about 7000 full-time equivalents or.
PN583
Right, so there's 7000 actual nurses employed but many of them are not full-time?---No, there's - - -
PN584
Sorry, there's 10,000 - what I meant to say, there's 10,000 approximately nurses actually employed but many of them are full-time and so on, and some are part-time. Okay, so of the 10,000 individual nurses, registered nurses, in the WA public sector, there's about, you say, 4800 members of the ANF. Is that right?---That would be the upper limit, yeah.
PN585
Now, those figures I've just quoted, in September 2000, just over a year ago when the survey was carried out, were they any different, were there more or less members of the ANF in September 2000?---Sorry, Mr Ellery, I don't understand the question.
**** KENNETH BRIAN JONES XXN MR ELLERY
PN586
Well, we've just established that there are 10,000 nurses in the WA public sector. Of those, about 4800 are members of the ANF. I'm just clarifying as at September 2000, when the survey actually occurred, were those numbers any different or were they substantially the same?---At September 2001?
PN587
Yes, no, no, September 2000 when the survey actually occurred, are those numbers any different or are they substantially the same?---They're very similar.
PN588
Okay. Who collated the survey, the survey returns?---The collation, I understand, was done by Personnexus Pty Ltd.
PN589
Okay. But at the time the survey was collated, you were actually employed substantively by Sir Charles Gairdner Hospital, is that right?---That's correct.
PN590
Now, if we can turn some pages into your statement, paragraph 67 in particular?---Sixty seven?
PN591
Sixty seven - six seven. Do you have that?---Yes, I do.
PN592
Now, are you a member of the Nurses Board of Western Australia?---Yes, I am.
PN593
How long have you been a member?---I was appointed to the Nurses Board of Western Australia in December 2000.
PN594
Okay. So I take it that your membership of the Nurses Board would mean that you are quite familiar with the Nurses Act?---Yes, I am.
**** KENNETH BRIAN JONES XXN MR ELLERY
PN595
And with the Code of Practice that is made pursuant to that Act?---Yes, I am.
PN596
Okay. Now, are you familiar that the Code of Practice refers to nurses working within competence, are you aware of that?---Yes, I am.
PN597
Do you agree that that provides another code, the Nurses Code of Practice:
PN598
The nurses, when delegating a task to other carers, a nurse should ensure that the carers are competent for the delegated tasks
PN599
?---Yes, I am, that's one of the requirements.
PN600
Is that a provision that's been within the Code of Practice only recently or is something along those lines been around for some time?---I - the recent code is - was issued in 2000 and that replaced the 1995 code and, that from memory, it was, the wording was similar in the '95.
PN601
Okay. So there was a similar provision in the 1995 Code of Practice. Now, can you just explain for the Bench - we've been talking about the Code of Practice - what actually is the Code of Practice and what is its status?---The status, the Western Australian Nurses Act 1992 allows for a Code of Practice. The Code of Practice endeavours to give nurses on the register a framework in which to guide their clinical and professional practice.
PN602
MUNRO J: I'm sorry. Could you just repeat that, I distracted myself?---It - it's - the Code is an allowable matter within the nurses legislation and it is a guide, a professional guide to - to nurses in their work settings or their professional roles.
PN603
And issued by the?---Nurses Board of Western Australia.
**** KENNETH BRIAN JONES XXN MR ELLERY
PN604
The Nurses Board, yes.
PN605
MS BURKE: If I might interrupt for a moment, your Honour. There is a copy of the Nurses Code of Practice as an attachment to Mr Jones' supplementary statement and it's attachment 8.
PN606
MUNRO J: I have to confess I couldn't fit Mr Jones' supplementary statement on the bag I took on the plane last night and I haven't myself read it, but I will. Could I just ask one question though that probably is not answered in that. You've referred to section 50 of the Nurses Act and it places an obligation on a registered person not to permit a person who is not registered to carry out any nursing for or on behalf of the first-mentioned person. What's the definition of "nursing" or is there a single agreed definition of what is nursing?---Within the - your Honour, within the Western Australian Nurses Act we actually don't describe or list what nursing is. The Act is silent.
PN607
Is there an established body of opinion or limited area of debate about what comes within the broad definition of nursing?---Within the profession there's agreed principles and standards but the current Act doesn't require us to provide a - describe or define nursing at this point, professional nursing at this point in time.
PN608
My question wasn't confined to the Act. Is there an established parameter of what comes within nursing of the kind that's there described, that is should be performed only by a registered nurse, for instance, the issuing of medication I would have thought is, or injections, is almost beyond question, a function that is proper to a nurse, sometimes even to the exclusion I think of medical practitioners, although I'm not sure of that. Are there other functions or tasks or generic descriptions of the work of nursing that the Commission could be taken to either in the material you've presented or that are within your knowledge?---I think, your Honour, what you are referring to is what we refer to in the profession as the "scope of practice" which is supported by other legislation that specifically names either enrolled or registered nurses, such as the Poisons Act.
**** KENNETH BRIAN JONES XXN MR ELLERY
PN609
Yes. Well, perhaps we can leave it there. It's not something where you can point quickly to these are functions that are proper to nursing, these are borderline and there's something that anybody can do?---Yes, you're right, your Honour, there is no, for example, a specific task or list but what may assist the Bench, the Australian Nursing Council Incorporated, we defined what we call our beginning practitioner competency so all registered nurses educated and beginning practice the level of competencies are defined and that's both for registered nurses or newly registered nurses and division 2 nurses which we refer to as enrolled nurses.
PN610
MUNRO J: Yes, thank you. I note the time.
PN611
MR ELLERY: Yes, your Honour. It's a convenient time to adjourn.
PN612
MUNRO J: 2.15. Thank you.
LUNCHEON ADJOURNMENT [12.44pm]
RESUMED [2.19pm]
PN613
MUNRO J: Mr Ellery?
PN614
MR ELLERY: Thank you. Mr Jones, before we left for lunch, we were considering some issues arising from the Nurses Code of Practice?---Yep.
PN615
Now, that document is actually exhibited to your second statement, attachment KBJ8. Could I ask you to turn to it. KBJ8?---Yep.
**** KENNETH BRIAN JONES XXN MR ELLERY
PN616
You have it? Okay. Clause 9, subclause (3). Could you turn to that, please. Now, that clause reads:
PN617
When delegating tasks to other carers, a nurse should ensure that the carers are competent for the delegated tasks.
PN618
Now, I understand that to mean that it is expected and understood that nurses will delegate tasks to other carers who are not nurses, but it must be within those principles. Is that correct?---Yes, that's correct.
PN619
That's correct. So okay. And could I ask you to turn back to clause 7, subclause (2) of the Code of Practice?---Mm hm.
PN620
Now, if you just read that to yourself, just so you're familiar with it?---Yep.
PN621
Okay. Now, I understand what that means is that if a nurse is concerned that nursing care that is being or will be provided is not appropriate, then a nurse is obliged to make that situation known to, effectively, someone with authority. It could be their supervisor, it could be somebody else in authority in the Health Service. Is that right?---Yes, that's right.
PN622
So looking at the two concepts together if you like, if a nurse is asked to work with a non-nurse and delegates a task to them, firstly they have responsibility to make sure that the carer is competent at that task, is that right, and secondly, if they believe that something inappropriate would be done, for example, the carer will be asked to do something that they should not be doing, that nurse is obliged to report that to their supervisor. Is that right?---Yes, that's correct.
PN623
Now, am I correct in assuming that nurses, in their everyday work, in clinical work, will carry out a range of tasks, some of which are of a high level skill and some of which are at a lesser level of skill?---Yes, that's right.
**** KENNETH BRIAN JONES XXN MR ELLERY
PN624
So for example, changing bed linen would be at a lower level of skill?---Yes, that's been suggested.
PN625
Well, would you agree with that?---I have no personal comments on - yep.
PN626
Well, among the range of tasks that nurses carry out, for example, at one extreme you must have nurses operating and monitoring highly complex technical equipment. Is that right?---Yes.
PN627
And that would probably be a more difficult and complex task than changing bed linen, would you agree with that?---Yes, I would agree with that.
PN628
Okay. Other less complex tasks that nurses can perform would include, for example, helping a patient walk to the toilet or to the shower. Would that be right?---It very much depends on the patient, Mr Ellery.
PN629
Fair enough?---So I don't want to make those generalisations. It's very much at the assessment of the patient.
PN630
Yes. I accept that. A patient with a low level of acuity, who is relatively well, assisting them to walk to the toilet or to the shower would be a relatively simple task, would you accept that? Whereas obviously a patient with higher acuity would be a more complex task. Okay.
PN631
COMMISSIONER O'CONNOR: Mr Ellery, when you refer to nurses, you're only referring to registered nurses, I take it?
PN632
MR ELLERY: Well, I should make that clear. I am referring to registered nurses in this context, Commissioner, yes.
**** KENNETH BRIAN JONES XXN MR ELLERY
PN633
Now, I would suggest, Mr Jones, is it not the case that in some circumstances non nurses can properly assist nurses to carry out less complex tasks?---In - yes, that's right, it depends on the facility and the service.
PN634
Yes, okay. Now, there are a variety of descriptions and titles and classification of non nursing carers, and Mr Olson went through some of those before?---Mm hm.
PN635
We've heard PCAs, HSAs, nursing assistants etcetera. Now, is there a generic term for that broad category of workers?---Yeah, within a profession we refer to them as unregulated workers.
PN636
Right. Are they also sometimes referred to as third tier workers?---Yep. Third level.
PN637
Third level. Okay?---Unregulated or third level workers.
PN638
Okay.
PN639
MUNRO J: What are the first two levels?---Registered nurses basically are in what we call division 1. Enrolled nurses are referred to, what we refer to in the Act as division 2.
PN640
Thank you.
PN641
MR ELLERY: Would it be correct in saying that some patients who have relatively low levels of acuity, that is proper and appropriate for a third level worker to assist a nurse to lift and turn the patient in the bed, for example?---Sorry, could you repeat your question for me?
**** KENNETH BRIAN JONES XXN MR ELLERY
PN642
Patients who have a relatively low level of acuity, who are relatively well, in some circumstances would it be appropriate for a third level worker to assist a nurse, a registered nurse in helping that person turn around in the bed, for example?---That's - yeah.
PN643
It would be?---That would be okay.
PN644
Okay. But in other circumstances, if they were more acute, it might not be appropriate. Would that be right?---Yes.
PN645
Now, in your experience, if something of that nature needs to be done, something of a simple nature with a relatively well patient, to use a lay person's language?---Yep.
PN646
I'm using lay person's language. I'm sorry if that confuses you, but someone with a low level of acuity, they require various assistance and if nurses are the only people available to provide assistance, then they would provide that assistance. Is that right?---Mm hm.
PN647
So things like walking to the toilet, nurses would do that?---Yes.
PN648
If they were the only people available. Lifting and turning in the bed, nurses would do that if they were the only people available?---Yep.
PN649
But if a third level worker was available, then it would be appropriate for that third level worker to help the nurse to carry out those tasks?---At the supervision of the registered or the enrolled - yeah.
PN650
At the supervision, yes?---Registered or enrolled nurse.
**** KENNETH BRIAN JONES XXN MR ELLERY
PN651
If there was no third level worker available though, the nurse would have to do it, or the nurses?---Yeah.
PN652
All right. So having those third level workers available can and does assist in easing the workload of nurses in those circumstances?---For many nurses, we would argue, it actually doesn't assist and it increases to the workload and to the stress.
PN653
All right. Let's say that a ward with four patients in it - - -?---Sorry, a ward with - - -
PN654
We will say just four patients who are of low levels of acuity and they require some basic level assistance such as walking to the toilet, changing bed linen, lifting and turning around in a bed. Now, would it not help the nurses in that ward if they had appropriately trained and qualified third level carers to help them carry out those tasks? It would?---Again, it depends on what the facility is and what the patients - the patients are in the facility for. If the type of patient you're suggesting, and I guess what's going in my mind is: why are they in hospital if they've got such a lower level of need?
PN655
Because they're recovering from surgery, for example, and they've almost fully recovered?---With our changes in the way we provide service, that type of patient, with our early discharge programs, we - we tend to basically send patients home a lot sooner. Our organisations have become - or our acute care facilities have become basically assessment, diagnosis and treatment facilities. Rest and recovery tends to happen more in the community and at home.
PN656
If a phone rings in a ward and there is no one other than nurses to answer the phone, would the nurses normally answer the phone?---Yes.
PN657
Presumably the phone message could be important, it could be test results or so on?---Yes.
**** KENNETH BRIAN JONES XXN MR ELLERY
PN658
All right. But if there was someone other than a nurse to answer the phone, such as a ward clerk?---Yep.
PN659
They could and would answer the phone?---Yes, they - they - if ward clerks are available, they usually are the primary person that answers the phone.
PN660
And that would be one less thing for the nurses to worry about?---Yes.
PN661
And that would help the nurses workload?---Yes, that does help when we have ward clerks.
PN662
If a patient needs help walking to the toilet and a properly trained third level carer is available to help a nurse to do that, does that help the nurse carry out that task?---Again, it depends on the specific patient. You may need - it's not just assisting the patient to go to the toilet. There may be - there may involve that the patient's body fluids needs to be collected. It maybe that the body fluids need specific inspection and there's no agreed standard on what appropriate educational training or competencies for the unregulated or the third level worker is.
PN663
In some circumstances, though, it would be of assistance to the nurse, I put it to you?---Yes, and again it would depend very much on the setting and the facility.
PN664
I'm not saying it's of assistance in every circumstance?---Yep. Yep.
PN665
I'm saying in some circumstances it would be of assistance?---Yep. What I'm - I guess what I'm referring to, yes, we use a high level of unregulated workers care - unregulated workers in our aged care facilities and settings.
**** KENNETH BRIAN JONES XXN MR ELLERY
PN666
I suggest that there are a number of patients in some WA public hospitals who are what is known as care awaiting placement patients?---Yes.
PN667
Can you explain what that term means?---These patients are elderly and they're waiting for permanent placement or permanent residency in an aged care service or facility. They're in our acute settings because the access to an appropriate aged care facility is problematic.
PN668
So if an aged care hostel bed was available?---They would be - - -
PN669
They would be in the aged care hostel, not in the hospital?---Yes.
PN670
So they are not very unwell, they're not very acute?---They - yes, they're basically recovered from their acute episode.
PN671
Yes. And with those patients, third level workers can assist them, can they not?---Yes, they can, but I would argue as a professional nurse, during that time, although they're over their acute problem and they are going to - and they do need permanent - a permanent residential care facility, the registered nurse can do and contribute to the restoration and improvement of many of their functions. So basically, when they do get to their residential facility, they will have the best or an improved quality of life with a whole range of things from continence management.
PN672
But if there was a bed available in an aged care facility, they would be in that bed, is that right?---Yes, that's right.
PN673
Right. Now, if you can turn back to, or you may still have it, paragraph 67 of your initial statement?---Yes.
**** KENNETH BRIAN JONES XXN MR ELLERY
PN674
And you refer to a copy of an email which you say has been circulated within Sir Charles Gairdner Hospital, which is attached to KBJ9?---Yes.
PN675
Now, the email refers to at one point, HSA. What is a HSA?---Hospital service assistant.
PN676
Right. Okay. And it also refers to PSA. What are PSAs?---Patient service assistant. Would you like to know the difference?
PN677
Yes, yes?---Patient service assistant takes on, in an acute care facility like Sir Charles Gairdner, patient service assistant is a combination of the traditional duties in cleaning, catering and orderly service. Within Sir Charles Gairdner Hospital they have a role of HSA which is basically - I will rephrase that. HSAs within Sir Charles Gairdner were orderlies, but the orderly system came back and it's a combination of orderly with cleaning functions.
PN678
And HSAs and PSAs are both third level workers, would you describe them?---Yep, they're both unregulated workers.
PN679
Now, I suggest that in some circumstances those workers could appropriately assist a registered nurse with some of the more basic care functions for some patients, such as walking to the toilet. Not going to the toilet but walking to the toilet?---They could.
PN680
They could. Answering a buzzer and assisting the patients if they're able. If they're able?---Yes, they could answer the buzzer and find out what the specific need is, but that's very specific on again the individual patient and whether they're - - -
PN681
Passing a message on to a patient. A patient's relative may have called with some particular news for them for example?---Yep, that could be done.
**** KENNETH BRIAN JONES XXN MR ELLERY
PN682
But if they're not available, presumably nurses have to do all those things by themselves. Is that right?---Yes, that's right.
PN683
Okay. So if they are available and if they're properly trained and they're properly supervised, they can assist the nurses carry out their work?---Yes.
PN684
Okay?---If they're, as you say, properly - I'm not sure what you mean by properly.
PN685
Yes. No, I'm not suggesting they shouldn't be properly supervised. All right. Now, in paragraph 68 of your statement, you refer to offences and the fines for those offences?---Yeah.
PN686
Now, in your time as a member of the Nurses Board, has a nurse ever been fined for not properly supervising a third level worker?---Not that I'm aware of.
PN687
Are you aware of that happening in recent memory?---No, not that I'm aware of.
PN688
You're not. Are you aware of a nurse being deregistered during your time on the Nurses Board for that type of activity?---No.
PN689
Are you aware of that happening in recent memory?---No, I'm not.
PN690
You're not. Okay.
PN691
MUNRO J: In the exhibit to which you were earlier taken, KBJ9, there's reference there, "Support staff do not feed patients". What's that mean?---It basically - the unregulated workers don't feed patients. That's done by enrolled nurses or registered nurses in case there's potential for a patient to choke while eating.
**** KENNETH BRIAN JONES XXN MR ELLERY
PN692
I see, you mean manually feeding?---Yeah. Yep. Within this - this is one of our major teaching hospitals and the nurses in this environment traditionally are used to having enough registered and enrolled nurses to do all the - meet all the patient needs, not work with unregulated workers. The unregulated workers within these settings have traditionally done those three domains of catering, cleaning and orderly functions.
PN693
Yes. Catering, though, would be done by unregulated workers, ordinarily, yes?---Yes. Not mostly personal care needs.
PN694
Okay.
PN695
MR ELLERY: Mr Jones, can I take you back to your statement at paragraph 26?---Mm hm.
PN696
You refer there to events that occurred on 15 January of this year?---Yes.
PN697
When nurses commenced a campaign about excessive workloads?---Yes.
PN698
Now, can you just explain what actually occurred at that time? Sorry, can I just focus that question a bit. I put it a bit broadly. What was the campaign that you were referring to and what actual action did nurses take as a result of that campaign?---The campaign at that time was nurses and those of us that were members of the Federation were concerned about patient safety with the non-availability of adequate numbers of enrolled and registered nurses and to meet patient safety they commenced reducing the bed stock to an appropriate level - an appropriate level of appropriate nurse/patient ratios.
PN699
So do I understand that to mean that nurses decided to close or not open beds?---Yes, that's right.
**** KENNETH BRIAN JONES XXN MR ELLERY
PN700
If there was not, in their view, sufficient nurses to staff those beds?---Yes, that's right.
PN701
And how was the formula or the ratio for how many staff to beds were required devised?---There was information provided through the Federation to members and non members within the ward settings and that's tabled and attached to other witness statements.
PN702
Right. Now, so the hospital you were working at at that time, Sir Charles Gairdner Hospital, that's a major teaching hospital as you say?---Mm hm, yep.
PN703
It's a hospital that normally is fairly full, is that right?---Yes, that's right.
PN704
So if a bed is closed, that means that a patient doesn't get to that bed, is that right?---Yes, that's right.
PN705
What happens to that patient?---That patient is usually an elective patient and their treatment and service is deferred.
PN706
Right, so a delay to that treatment?---Mm.
PN707
And just so I'm clear, the ANF devised ratios, communicated those to ANF members, is that right?---Yes, that's right.
PN708
And the members themselves simply imposed those ratios by not opening beds or by closing beds?---Yes, that's right.
PN709
It wasn't done in consultation with the management or the hospital manager or anything like that?---I believe it was done in consultation with management in my own experience. I was the nurse co-director, I was the nurse manager. I had the prime - - -
**** KENNETH BRIAN JONES XXN MR ELLERY
PN710
Did the hospital management agree with it?---Mm?
PN711
Did the hospital management agree to it?---No. We definitely didn't agree with - with the action.
PN712
Do you know how many beds were closed at that hospital, Sir Charles Gairdner, as a result of the events?---Yeah, I think - I can't remember off hand but there - it was a significant number.
PN713
Did all nurses participate in the industrial action?---No.
PN714
All right. If we can take you further on in your statement, paragraph 61?---Hmm.
PN715
Now, you have explained that for - in recent years you have worked at Sir Charles Gairdner Hospital?---Yes.
PN716
You haven't been working as an agency nurse working in a variety of different hospitals in recent years?---In recent years, I do agency - I do the occasional agency shift just to keep my clinical skills valid.
PN717
At paragraph 62 you make some broad statements about what you describe as working time and the characteristics of nurses working time. Do you have any statistical or empirical evidence to support those statements?---I think that basically the statistical evidence that I have been exposed to has been in my professional role as an executive nurse in the system, to know that in the areas I have co-managed we used far more agency and casual nurses over the last 5 years. Statistically, I never recorded. All times when my own nurses complained that they were unable to take their meal breaks, the skills mix is about problematic. But we don't have good data to manage or good data to review. But from my - my experience base, I believe all those statements are reasonable on what has been happening within the work settings.
**** KENNETH BRIAN JONES XXN MR ELLERY
PN718
Are you saying that that is the experience of every nurse in the Western Australian public sector?---No. It is a generalisation. More, it would be - the awareness is more in those that have mostly chosen a management stream.
PN719
SENIOR DEPUTY PRESIDENT O'CALLAGHAN: Mr Jones, what is the link between, as you put it, the proliferation of agency work and the more generic issue of workload?---Well, if you look at Perth, say, 10 years ago, this State had about three nursing agencies. The last time I looked in the Saturday morning paper, I counted 19 nursing agencies.
PN720
I understand that but - - - ?---Yep.
PN721
- - - what is the link between the proliferation of nursing agencies and the workload issue?---I guess one reason that I believe nurses go and work in agencies is because they can control their workload by controlling when and where they work.
PN722
MR ELLERY: Thanks. At paragraph 63, you talk about occupational health and safety?---Yep.
PN723
And you refer to the health sector having higher rates of occupational injury than most heavy industry. What do you mean by "heavy industry"?---Basically heavy industry is anything from driving trucks in mine sites to laying bricks to - I am referring to manual industries, other manual industries.
PN724
Have you seen any studies or statistics to support that statement, the first sentence of that paragraph?---Yes, I have.
PN725
When you say "the health sector", what are you referring to?---The health industry.
**** KENNETH BRIAN JONES XXN MR ELLERY
PN726
Right. So you are referring to - - - ?---Hospitals and services.
PN727
- - - people other than just registered nurses, I take it?---Hmm.
PN728
It includes orderlies, for example?---Hmm.
PN729
Third level workers. It includes doctors, administrators?---Yes. And there is very high incidence of needle stick injuries within our medical staff colleagues.
PN730
In paragraph 64 you look at - you say that: "Nurses are frustrated and feeling extremely stressed" etcetera, etcetera. Now, which nurses are you talking about?---I am talking about nurses generally. Because there is - over the years - nurses generally, it means over the years there is basically more and more pressure within the work environment so we cannot basically fulfil the requirements, whether they are ideals or with our education. And you - a term that is becoming more used is providing essential care. So there is less and less time to provide what we call in nursing holistic care. So the tendency for many nurses is to basically feel that they haven't been able to complete all the things they would like or need to do for patients and, therefore, work satisfaction is on a downward spiral. I guess I will add to that, all nurses know that some shifts are exceptionally busy and you do - you can only provide essential care. But those shifts are getting more and more common. So, therefore, the work satisfaction is generally decreasing. And that has basically been demonstrated right across the nursing sector.
PN731
Now, this is a generalisation, is it not?---Yep.
PN732
Okay?---But I believe it is backed up with appropriate studies of nurses and nursing in this State, nationally and international.
**** KENNETH BRIAN JONES XXN MR ELLERY
PN733
So when you say are nurses frustrated, are you talking about nurses throughout the world?---Yes.
PN734
Okay. Some of these problems, you say, are common throughout world, is that right?---Yes, they are.
PN735
Okay. If I can take you further on in your statement to paragraph 70. You refer here to a survey that the ANF conducted in February and March of this year?---Hmm.
PN736
Do you see that? And you say that a summary of that is attached to exhibit 10, KBJ10?---yep.
PN737
Now, this survey, who actually carried it out?---This survey was an initiative that we undertook in the working party with recruitment and retention which is - was looking at workloads. So it was - - -
PN738
Sorry, if I can just stop you. If you can just explain for the Bench, when you say "the working party," what do you mean by that? In what context was there a working party?---Right. In - I think it was March, from memory - sorry, it was after the January health and safety action that we back in the Commission. The Commission recommended that four working parties be set up to look at four issues within the ANF log of claims. And they were.
PN739
So this is in relation to enterprise bargaining negotiations that were on foot?---Yes, that is right.
PN740
Okay?---Yep.
PN741
MUNRO J: Was the working party with the WAGHI, was it?---Yes. Yep. We had three members from the Federation and three members from the WA Government Health Industry.
**** KENNETH BRIAN JONES XXN MR ELLERY
PN742
MR ELLERY: Okay. So this survey you are referring to, this was conducted by ANF representatives to that working party. Is that right?---Yes.
PN743
It wasn't a joint survey?---No. From memory, the Health Department representatives didn't want to contribute and were quite happy for us to collect data and present.
PN744
And how was this survey carried out?---The survey was basically in three sections and that was sent across the State, to our members across the State. And it was a voluntary activity. They could indicate their current problems, what they thought was needed to rectify those current workload problems. And the third section was to add other information that they would like to either resolve or see progressed.
PN745
And did you receive a high rate of return?---Yeah, I was very pleased because it was a limited time so from memory, we got 3 to 5 - over 300. Under 500.
PN746
This is from your amongst your membership in the WA public health sector?---Yes.
PN747
Now, you have attached a summary of comments?---Hmm.
PN748
Who compiled that document?---I compiled this document. They are direct statements from the data sheets.
PN749
Okay. And it is a - from what you have described it is a small selection from a number of responses received?---I don't believe they are a small selection.
PN750
Is it less than half of the responses received?---No, I think they are probably about 70 or 80 per cent of the responses. The other responses, I would suggest, were not related to workload and workload issues.
**** KENNETH BRIAN JONES XXN MR ELLERY
PN751
You haven't attached the other responses though. So we don't know what they say?---No.
PN752
And you decided what responses should go in the summary, is that right?---Yes, I did that with - in collaboration with the other members of our representation on the working party.
PN753
The other ANF members?---Hmm.
PN754
Okay. Further on in your statement at paragraph 73, you make the comment that:
PN755
Nursing has become more task focussed with little if any time available for professional development.
PN756
Now, on what basis do you make that comment? On your experiences, is it?---Yep. No. Not just my experience but the experience of many colleagues. What that means is patients have to come first so patient needs must come first. So, therefore, patients that have needs and require care are the priorities. So the availability, if there is a tutorial on a clinical practice issue or a new piece of equipment, well, if there is not enough nursing resource, well, the patients have to come first, so there is less opportunity. So although we do have in many of our facilities still education stream or staff development support - - -
PN757
Look, I have got to stop you there. You are not answering my question. My question was, was that based on your experience or on what was it based?---Sorry, I didn't hear that. That is based on my experience and I would suggest the experience of many of my colleagues.
PN758
Right. Could you turn to one of the attachments, it is the first attachment to your statement. And it is actually the last page I am referring to. So it is immediately before KBJ2?---Sorry?
**** KENNETH BRIAN JONES XXN MR ELLERY
PN759
It is the page which appears immediately before the second attachment or exhibit. So it is a page which is headed: Continuing Professional Developments?---Yes, that is out of my curriculum vitae.
PN760
Right?---Yep.
PN761
So that reflects professional development that you personally participated in in the 6 months from - - - ?---Yes.
PN762
Well, the 5 months from July to November of last year?---Yes.
PN763
Including, what, a 2 or a 3 day conference in Fraser Island, Queensland?---Yes, that is right. The - - -
PN764
Did the Hospital assist with the cost of that?---I think that is one of the few times actually the Hospital did assist with the cost of that.
PN765
Yes, okay?---I got a thousand dollars, from memory.
PN766
So based on your experience, you say that there is little time available for professional development, yet in a period of 6 months, you have been to Fraser Island for two days and you have been to, what, is it 10 or so separate professional development events?---Yes.
PN767
All right. But based on your experience nurses have little time for professional development. Okay?---Yes.
PN768
That is fine?---Yes. I - unlike many of my colleagues, I don't have their other responsibilities in life.
**** KENNETH BRIAN JONES XXN MR ELLERY
PN769
Certainly. Moving on to paragraph 74, you talk about a number of things. Inappropriate skill mix; insufficient staff numbers, etcetera - "this is leading to a desire by nurses to leave the profession." Now, I assume again, here we are generalising. This is what you say some nurses believe, but it is not what every nurse believes, is it?---I don't believe it is what every nurses believes but I believe that you can generalise that there is even - there is a State study that have been tabled by our Principal Nursing Adviser that will support that generalised statement. As well as national and international.
PN770
Okay. Moving on to paragraph 87, you are talking there about nursing hours per patient day?---Yeah.
PN771
And you say that:
PN772
That reduces elements that contribute to nursing workloads to only very basic variables, patient numbers and nursing hours.
PN773
Correct?---Yep, that is right.
PN774
Now, the nurse/patient ratio that the ANF has proposed considers patient numbers, availability of nurses, which in one way reflects nursing hours and skill mix, is that right?---The ratios themselves don't refer to skills mix.
PN775
No, but - - - ?---Part of our draft order, our original draft order - - -
PN776
Your proposal. So the ratios themselves don't even refer to skill mix?---No.
PN777
They just refer to number of patients and number of nurses available?---Yep, both. Whether it is nursing hours per patient day or nurse/patient ratios. They come down to those two variables.
**** KENNETH BRIAN JONES XXN MR ELLERY
PN778
Okay. So they both have that common theme?---Hmm.
PN779
Okay.
PN780
MUNRO J: Pardon me, Mr Ellery, could I just take you back, Mr Jones, to paragraph 82. Were you going to come to this, Mr Ellery?
PN781
MR ELLERY: No, I wasn't at this stage, your Honour. So I am happy for you to deal with it.
PN782
MUNRO J: Very well. You say there that currently in the system, nursing FTE numbers are established by guesstimation. In your - the attachments, if you go KBJ5, that is the proposed nurse/patient ratios compared with actual data?---Yep.
PN783
I suppose the first point about the actual data sofar as you are actually aware, the actual figures are not challenged. They are ones that you have accumulated by inquiry yourselves?---Yes.
PN784
And at what time is this broadly accurate?---That was mostly done at the time or following the January safety and health action taken by nurses. There was sheets provided to the membership.
PN785
Well, what I am going to, is if you look through Royal Perth Hospital, the actual data for medical/surgical comes up with 1.6. At Sir Charles Gairdner, medical/surgical 1.5?---Yep.
PN786
Fremantle 1.6?---Yep.
**** KENNETH BRIAN JONES XXN MR ELLERY
PN787
Princess Margaret 1.6?---Yep.
PN788
There appears to be a relative consistency in the actual data, not only in that respect but scattered through the different areas. Is that a product of accident or some form of consistent guesstimation?---I think it is a product of historical allocations. So - - -
PN789
So, the historical allocations have been broadly reflective of the bed or patient/nurse ratio or nurse/patient ratio?---Sorry, I - - -
PN790
Well, if you take a figure, if for instances, 1.6 which is relatively consistent in the Medical Surgical Ward?---Yep, right throughout the - yeah.
PN791
You were saying that's a pattern of historical allocation but what does that mean? That there's been one nurse to 6 beds?---Yeah, probably since the early 80s 1 to 5, 1 to 6 in general medical, general surgical areas were applied in the early 80s.
PN792
What are we to infer from that, that it's purely haphazard that this has been occurring or has there been some guiding hand that - - -?---Well, the guiding - - -
PN793
- - - tends to identify there are 6 beds or 12 beds to the ward, that's 3 wards, we will put in 2 Registered Nurses for that requirement?---I - I would suggest the guiding hand has been the - the budget, so, on a hysterical[sic] perspective, that's the allocation and that's the amount of nursing time that you can buy with the nursing resource.
**** KENNETH BRIAN JONES XXN MR ELLERY
PN794
I know in your supplementary statement there is quite considerable additional material and I have only glanced at the title of the articles, I think, than at the substance of them, but is there anything that shows us the historical pattern of Registered Nurse allocation against, I suppose, beds, for want of a better term, over the years in Western Australia, how many nurses, how many beds?---That - obtaining that type of information is exceptionally problematic and - and I, myself, haven't tabled that in my submission and I haven't been able to find it within the published documents from the Health Department.
PN795
So, so far as you're aware there is at no stage in Western Australia a relatively concrete rule of thumb that would have explained how that relevant consistency and the actual data came about?---No.
PN796
Some of the actual levels don't appear all that far apart from some of the proposed levels, for instance, in California?---No. The areas that - that are close, I would suggest - if they were reduced to a nurse that would make a significant difference to basically your patient outcomes and what patient needs you can meet, so, the - the only proposed ratios are definitely modelled on the Californian and the Victorian ratios. They're our - - -
PN797
I'm sorry, which ones?---The first column, the proposed ratios.
PN798
Yes. Yes, your proposed ratios?---Which are based on the Victorian and Californian ratios.
PN799
Yes?---And the others - the data that our membership - - -
PN800
Well, for instance, I'm looking at them - I'm just looking at the first one, medical/surgical in Perth, it's 1 to 4 and then plus SC, what's SC?---Shift Coordinator. Someone to - a nurse to manage the ward.
**** KENNETH BRIAN JONES XXN MR ELLERY
PN801
I see. So it's effectively 1 to 5?---Yep.
PN802
There being a Shift Coordinator on all shifts or only for the 24-hour period?---Just for the 2 shifts we've suggested. The morning shift and the afternoon shift, to have someone to basically coordinate the ward activities. The doctors' rounds, the - the pharmacy coming, the discharge of patients. All those types of functions.
PN803
Yes. Just tell me at, if you know, Royal Perth Medical surgical, what are the shifts, are they 8, 8, 10 or I thought there was something that suggested the 10 had gone by the byway?---Yeah. I believe - most of the teaching hospitals budget in the nursing service for the morning shift to be 8-hour shifts but the afternoon shifts to be short shifts whether they're 6 or 7 hours in that.
PN804
I see?---And then there's a difference in the night shift length.
PN805
That varies?---Yeah. It can be - - -
PN806
Yes, thank you.
PN807
SENIOR DEPUTY PRESIDENT O'CALLAGHAN: Mr Jones, before you leave KBJ5 can I just ask you to confirm to me that the column headed, Actual Data?---Yep.
PN808
Is the actual nursing allocation rather than necessarily the exact number of nurses? So, could the column be re-badged as the full time equivalent allocation or does it take account of, as actual data, the extent to which any one of those hospitals and any one of those areas within the hospitals, may be operating at less than their full staffing complement?---The actual data is data that members said that's what they were working on in those areas. We - in the working party we asked the employer for rosters and - so we could do rosters and patient occupancy so we could do some of our own interpretation. That wasn't tabled, so to get a feel we conducted this survey to see what ratios nurses were currently working on throughout the State.
**** KENNETH BRIAN JONES XXN MR ELLERY
PN809
So that if I were to look, for instance, at the Royal Perth Hospital in the medical/surgical area, we see that actual data is 1 to 6. In the event that that was an area that was working without its full complement of nurses, is it possible that that area would be funded for a higher ratio of nurses to beds?---That's something I didn't measure and that's something that we couldn't get from that particular survey.
PN810
MUNRO J: Yes, Mr Ellery?
PN811
MR ELLERY: Thanks. Just while you're still on that exhibit, Mr Jones, I take it that one common theme between all the different awards that have identical or similar ratios is that they are managed by senior nurses, is that right?---Yes, that's right.
PN812
Rosters are, at least in part, developed by the senior nurses?---Yes, that would be right.
PN813
Who have been through similar or identical training?---Um, yeah, we're trained as clinicians.
PN814
Yes?---Not as managers.
PN815
No. Okay. Can I just clarify one thing?---Mm.
PN816
Of a more general nature, in public hospitals in Western Australia, putting aside Mental Health Services, does the ANF cover Enrolled Nurses?---From a industrial point of - - -
PN817
Well, do you have - are you parties to an award or agreement that covers Enrolled Nurses?---No, we're not.
**** KENNETH BRIAN JONES XXN MR ELLERY
PN818
You're not?---No.
PN819
Okay?---No, but we do - - -
PN820
And another union, the Miscellaneous Workers Union is, is that right?---Yes. Yes, that's right.
PN821
Okay. So where the proposal of the ANF exhibit B1, determines the skill mix including the percentage of Enrolled Nurses, the Enrolled Nurses as referring to there, are nurses who are covered by awards and agreements that another union, the Miscellaneous Workers Union, is a party to, is that right?---Mm.
PN822
Okay?---But at the end of the day we may not - there are no - maybe not covered by - from an industrial perspective by the Australian Nursing Federation but from a professional point of view, they work at the supervision direct or indirect of the Registered Nurse.
PN823
Yes. Whereas in Victoria, by contrast, Enrolled Nurses in Public Health are covered by the ANF for all those purposes including an agreement and an award, is that right?---Yes.
PN824
Can I ask you to look at your supplementary statement?
PN825
MUNRO J: Sorry. Just before you go to it, Mr Jones, Enrolled Nurse, is that a broadly consistent concept nationally?---No. Unfortunately it's not. We, in this State, for many years had a 2-year education program for our Enrolled Nurses. That recently - in 1999, I think it was, was reduced to a certificate for 18-month course where our Eastern States colleagues have always only had 1-year education for the Division 2 nurses, so - - -
**** KENNETH BRIAN JONES XXN MR ELLERY
PN826
And does the Enrolled Nurse have any form of registration, they're regulated, you say?---Yeah, they're regulated. They're - most Acts they're regulated in Division 2.
PN827
And the legislation normally identifies, what, within the scope of the functions?---Yeah, yep. Yeah, there's - that's the - the second level nurse, the Enrolled Nurse is there to - to basically look after the more stable - the more end stage before discharge patients that - it's being suggested that that's what the third level worker or the unregulated worker should now - now be taking care of. So, we've always had a two-level system in this country that's worked very well. So, the less acute - the - the less complex patients our Enrolled Nurses look after and the frees up Registered Nurses to look after the more acute and the more complex. And that's patients and tasks.
PN828
Mr Ellery?
PN829
MR ELLERY: Thanks. I don't need to take you to the other statement, your Honour. I think we've dealt with those matters.
PN830
You've heard the evidence that there were some 3000 nurses made redundant in Victoria between 1992 and 1997?---Mm.
PN831
n WA there have been no such redundancies of any similar nature, have there?---We had nurses being offered redundancy at different points when it's - - -
PN832
No. I'm talking on a large widespread scale?---No; no.
PN833
Yes. I have nothing further, your Honour.
**** KENNETH BRIAN JONES XXN MR ELLERY
PN834
SENIOR DEPUTY PRESIDENT O'CALLAGHAN: Mr Jones, prior to working at the Sir Charles Gairdner Hospital, you worked for a period at the Hollywood Private Hospital?---Yeah, that's right.
PN835
Are you able to tell me whether or not, and I note that it's some time since you did work at the Hollywood Private Hospital?---Yeah, '94 to '95.
PN836
Whether or not there is a difference in the way in which those two hospitals determine the staffing needs they have to cope with designated workloads?---My experience in the private sector is they were - they had been utilising what we call, nursing hours per patient day, for some 15 years. So, within the private sector - the - most wards have some bench mark that you try and contain your resources within. So, generally at Hollywood on a general medical - surgical unit, it was 5 hours per patient per day.
PN837
Thank you. Can I refer you to paragraph 14 of your initial statement?---Yep.
PN838
In this paragraph you indicate you were:
PN839
...able to demonstrate that the nursing hours required to provide essential care were insufficient by tracking nursing hours per patient
PN840
?---Yeah.
PN841
Can you tell me what you mean by that statement and how you went about doing that?---Yep. After my - as you can see - by my curriculum vitae I've predominantly worked in the teaching hospital sector. After I came back to the - the public sector, I was - that's at the - I had been down - basically doing my Masters for a couple of years and on - and my thesis is around to patient classification, patient acuity. What I was trying to do is take that broad concept of nursing hours per patient day to see if I could turn that into a tool to assist
**** KENNETH BRIAN JONES XXN MR ELLERY
nurses so - because are all well aware that in - in a hospital in an acute care facility, there's peaks and troughs in activity so I was trying to - to develop a tool. So, you know, when nurses in one of my particular units needed 9 nurses on that shift to provide the care, that we could have some way of understanding when occupancy and acuity was low and we would work on 4 and that would balance - balance the resources out because at - at the moment we're working blind. We don't have any system. So, what I was doing was - I was - I commenced tracking just by taking - because in my role I had access to the patient occupancy data as well as to my nursing hours data. And then I would come across a whole range of problems. The occupancy data statistically for the hospital is only collected at midnight and usually that's when the occupancy's at its lower [sic] so I actually started measuring occupancy at 7.00am, 2 o'clock and - and midnight. And basically, what - what I was - the total hours to dollars defines the nursing hours you can - you can give and what I was finding was that the dollars or the hours provided through my budget were at a minimum but the actual care that the patients in my units required, was higher than the budgeted hours so we could only provide that essential level of care. Unfortunately, in a - in a volatile health setting like a teaching hospital, my - my data become less valid because we kept consolidating beds and changing specialties and a whole range of other things so I could never take it to that - to that next level. But my - my intent was at that point to find a workload or a - a patient classification system that could assist ward based nurses. So, I persisted on for about 2 years but then with the changes that were happening internally and externally within the organisation made the data collection impossible. And it was all, at the end of the day, done manually which made it very labour intensive.
PN842
Does the Sir Charles Gairdner Hospital have a system which, or is it developing a system which tracks workload on a more regular basis?---Well historically in the late '80s we actually did develop Sir Charles Gairdner a - a patient classification a nursing acuity or a patient acuity system. Unfortunately that fell out of - of favour with both nurses like myself in management and nurses providing the care because we were never able to - provide the level of staffing the acuity system was suggesting and unfortunately, with that acuity system, is what I hear more and more, it was based on time and motion studies but unfortunately that may be the way a graduate nurse may work linger[sic] but an experienced nurse, you will find is doing 2 or 3 things at the same time. They may physically be walking that patient to the toilet but they're already thinking about setting up that dressing trolley for that procedure and that they
**** KENNETH BRIAN JONES XXN MR ELLERY
need to ring the doctor and report - report X. So traditional time and - and motion studies are problematic and there's - the other problem is with looking at nursing from a task perspective, and that's what we don't define in - in the - the Nurses Act. The nursing phenomena is more than just tasks and how do you actually measure that is the challenge to the profession. So - so we did have it at Sir Charles Gairdner an acuity system but with changes of members of the hierarchy and so on, it fell out of flavour and it was through my experience in the private setting and - and talking to the Acting Director of Nursing, she was at that time, that's when the public system or the - Sir Charles Gairdner and the other metropolitan public teaching hospitals started looking at nursing productivity or nursing hours per patient day formula.
PN843
A final question, Mr Jones. When a designated area within the Sir Charles Gairdner Hospital has reached capacity, due to either the beds being filled or the nursing staff not being available, can you explain to the Commission the process that is followed whereby patients are not left untreated in any way?---Yeah, well unfortunate - if you look closely at - and I've been able to been able to because of my experience based there, you know, 5, 6 years ago, Sir Charles Gairdner probably ran on an occupancy level of about 85 percent. If you look closely now, they run - some days are - are over a hundred percent and that's what we call, hot bedding. The computer system hasn't, or the patient management system hasn't caught up with the discharge and the new patient that's gone into that bed area. We went through a number of years of placing an additional patient in our corridors on our wards because we thought that was better than leave these patients in our Emergency Department. Unfortunately, those - placing patients in corridors isn't appropriate - appropriate. They've got no access to privacy or basic comfort facilities such as toilets. So - so at the end of the day when units are full in - in a facility like Sir Charles Gairdner Hospital and their - and all units are filled, the only place to basically leave the patients is in the Emergency Department which is problematic because you're trying to deal with a whole range of acuity of patients and there's only X nursing resource to deal with that and then you've got patients that are waiting for extended periods while discharge processes take place and beds are freed up. So, I think that's similar from what I've seen because I've sat on hospital executive for - for 5 - 5-and-a-half years and that's a trend within our facilities across this town with the teaching hospitals. But the occupancy of our secondary hospitals is - is significantly lower but unfortunately we don't have the infrastructure to basically provide more service in our secondary hospitals. At this point in time we don't have the capital.
**** KENNETH BRIAN JONES XXN MR ELLERY
PN844
MUNRO J: The secondary hospitals, being which ones?---Sorry?
PN845
The secondary ones are the non teaching ones?---Yeah. They're our Group Bs, yeah. They're within our - - -
PN846
SENIOR DEPUTY PRESIDENT O'CALLAGHAN: Group Bs?---Yeah. What we've defined as our Group Bs.
PN847
Presumably in some instances where you were at the 100 per cent rate, patients would be referred to other facilities?---If that was possible, but it's predominantly because of the lack of infrastructure in our secondary hospitals and the lack of - it's more the lack of the availability of medical practitioners. There's many that you actually can't send back to their local community hospital.
PN848
Because of the nature of the therapy that you've got - - -?---Yeah, their illness and there's not access to the equipment and there's not access to the medical resource.
PN849
PN850
MS BURKE: Thank you, your Honour.
PN851
Mr Jones, Mr Ellery asked you in some detail about the third level carers or the PCAs or HSAs or orderlies, the description seems to vary, and the question arose that, is it possible for a PCA to undertake some of the tasks such as walking the patient to the toilet or answering a buzzer or passing on a message from a relative to the patient, and you indicated that the registered nurse, that the workload increases with the use of those third level carers. Could you
**** KENNETH BRIAN JONES RXN MS BURKE
explain what you mean by that?---What I mean by that is, in our acute facilities, which is our teaching hospitals and our secondary hospitals, whether they're rural or metro, nurses generally aren't used to working with unregulated workers. In the aged care sector it's different. There's a history. So traditionally we usually have enough nursing resource. Now it becomes - it increases the working load because as a registered nurse, you don't know what training or education the qualified or the unregulated worker has and it can be from no training to some facilities are running a 5-day program. It can also increase your work load because again, looking at nursing in tasks is not how nursing should be viewed. That walking to the - that patient to the toilet, you may be having a feel for their balance or do they have a particular disorder, and you may need to describe that either to the appropriate medical person or the appropriate Allied Health individual, whether it's a physio or an OT, so it does increase your work load because you're going to have to observe that patient or get that information and what you can't tell when you've delegated a task that's as simple as walking, is whether that's a progressive disorder or not, because nurses would basically maintain a 24-hour service. We collectively - and we exchange information, either written or verbally. A patient could be getting more unsteady and needing more assistance, but unless you're actually doing that particular - assisting with that particular issue, you don't know. So therefore it does add to your work load because you need to ask and then if you're asking uneducated or untrained support workers, well, they don't know what they're looking for and they don't know what they're describing, so - - -
PN852
And it's an additional responsibility on the nurse?---That's right. It's problematic because if the patient does have an adverse event, well, it's the registered nurse that's responsible.
PN853
Okay. Just going back to a question that Mr Ellery asked about the occupational safety and health injuries, I would just be interested to know if, in your experience, you've ever seen any evidence of occupational safety and health statistics, specifically for registered nurses?---Yeah, I have. I've been involved in safety and health for many years and there's many available published papers that will demonstrate that health care workers are at risk for a whole range of work-related injuries and nursing itself is at risk and again, nursing is about 40 per cent of our professional work force, so just in numbers related to the things we do, basically an increasing number, and the potential. And once you basically solve one set of hazards, you get new sets of hazards and one that's coming through more and more now is the violence and aggression towards nurses in their work setting.
**** KENNETH BRIAN JONES RXN MS BURKE
PN854
Thank you. Mr Ellery also asked you about professional development and he made a point that you have personally experienced quite a lot of professional development. I would just like to ask first of all; at Sir Charles Gairdner Hospital, were you employed in a senior nursing position?---Yeah, I was in a nursing executive position.
PN855
And is it the case that nurses in senior nursing executive positions have more time for professional development than bedside nurses?---At the end of the day, you could say we have more money so we can buy more professional development than other nurses that don't earn that money. With myself, I have my own standards and I believe for myself that I need to go to at least one professional development event per month and I do take the opportunity to use my disposable income to go interstate a couple of times a year. Then I'm not competing with my colleagues that have other life expenses such as school fees and a whole range of other things.
PN856
So the professional development that is listed in your CV, was that done in your own time or in the employer's time?---Besides those three days in Fraser Island on that sheet, that was all done in my own time. So it's all after hours. I mean, it's part of the professional organisations that I'm a member of.
PN857
Okay. And are you aware that the recently certified Nurses WA Government Health Industry Agreement contains provisions in relation to mental health enrolled nurses?---Yes I am, yes.
PN858
Now, just another question in relation to redundancies in Western Australia. Are you aware that in 1991 and 1992 the State Government did offer widespread redundancies to nurses?---Yes, I am. I couldn't remember when it was, but I do remember, yep, there was a whole range of nurses that took up that offer at that time.
PN859
Can you remember how many redundancies were offered?---No. No. But many of them took their redundancy and then the requirement was you couldn't work in the public system, so they went to the private sector.
**** KENNETH BRIAN JONES RXN MS BURKE
PN860
One more issue that came up was in relation to the length of the shifts, and you mentioned that in the afternoon there are frequently 6 or 7-hour shifts rather than traditionally the 8, 8, 10 roster. Could you tell the Commission what the impact of those shorter shifts has been? Has it had an impact on work loads?---Yeah. This was an initiative that came in about '92, '93. All hospitals basically moved to decreasing the shift, what we call the shift overlap, which is between the morning shift and the afternoon shift. If you look closely, with the 10-hour night shift there's a period from 1 o'clock till 3.30 that we call the shift overlap. Now, we've traditionally used that time to do a whole range of functions, whether that's in-service education or quality improvement activities or some complex patient tasks, like you may need two nurses to do a particular dressing so as we've all moved to implementing short shifts, we've lost that available time, so that's either affected - basically it's increased the work load directly of nurses or we've lost the available time. Again, in that time we did what we call our core education, which is our basic life support review, our annual update on infection control, our annual fire and safety review, so it's harder and harder, with short shifts, for us to meet even core functions.
PN861
So has the overlap gone?---It's not that it's - it's significantly left and mostly with the - the more nurses, as nurses move to casual and agency employment, well, basically you employ them on a 6-hour shift. That will cost you about 8 hours money with commissions and the 20 per cent loading and so on.
PN862
Thank you. Thank you, your Honour.
PN863
PN864
MR ELLERY: Your Honour, before the next witness is called, I did have a submission in relation to the admissibility of some of Mr Jones' evidence. I don't need to deal with that right now if you don't wish me to, but if it's convenient for the Bench, I could deal with that now.
PN865
MUNRO J: Very well. Go ahead.
PN866
MR ELLERY: The evidence I'm referring to are the two surveys or reports or summaries of surveys that have been provided, one of which is provided at KBJ2. That is the longer of the two documents. And another which is provided at KBJ10. Our assertion is that both of these surveys and the evidence that is provided to substantiate them is so far removed from substantiating them or validating the survey methodology that they should not be ruled admissible. They should be deemed to be inadmissible. We raise this issue very squarely in our submissions, which were filed on 30 July, and I note that at that time we cited two of the relevant authorities, the Interlogo case and the Arnotts v Trade Practices Commission.
PN867
So the ANF had ever opportunity to choose to respond to that complaint about the lack of substantiation of these surveys and didn't do so. And frankly, from my perspective, the surveys have now less substance now that we've heard from Mr Jones, because Mr Jones simply can't testify as to KBJ2. He has no direct knowledge of it. He wasn't responsible for it. It's well established that surveys are hearsay and therefore commissions and courts should be at great pains to examine them and scrutinise them carefully and scrutinise the methodologies that were used to produce the surveys and the findings of those surveys before admitting them into evidence.
PN868
We're not here in a court, we're here in the Commission and obviously the rules of evidence are not strictly applied here, but nevertheless we say that in this case the surveys are so lacking in substantiation and in background information as to how they were collected, who collected them, who compiled the material. None of the raw data is provided to substantiate that process. Generally they are just so lacking in all the matters that one would expect to be provided that they should simply be declared inadmissible. And that would be KBJ2 and KBJ10 and relevantly, paragraphs 21 and paragraph 70 of Mr Jones' initial statement which deal with the effects of the surveys.
PN869
I stress, your Honour, that this is not an ambush. We raised this very squarely on 30 July, the difficulty we had with the initial survey, but the ANF have for whatever reason chosen not to properly address that.
PN870
COMMISSIONER O'CONNOR: Can you demonstrate where it's wrong then?
PN871
MR ELLERY: No, I can't demonstrate where it's wrong. I can't demonstrate where it's right, to be frank, because there's just nothing there. I mean, all we have is these very bland assertions that they were distributed, not really sure who they were distributed to, not really sure what was done to make sure that no one completed more than one survey. Not really sure as to whether some members may have got more than one, whether some non members may have got one of the surveys. I mean, none of that evidence is there. If there was some of that, we wouldn't be making this application, but we simply can't judge. We can't judge how reliable these things are.
PN872
As I stress, we haven't just raised this today. We raised it very squarely in July and the ANF chose not to respond to that, and now that we've heard that Mr Jones, who is the only witness who can attest or chooses to attest to KBJ2, which is the longer survey, he had no direct knowledge of it, effectively. What reliance can be placed on this? It's so far removed from being substantiated that it simply shouldn't be admitted, in our submission.
PN873
MUNRO J: Yes, thank you, Mr Ellery.
PN874
MR CASTIGLIONE: Yes, with the Full Bench's permission, I would like to deal with this issue. The original submission made by the employer in this issue never went to admissibility at all. If one examines what was said at paragraph 43, the original objections always went to the issue of weight. So nothing was ever said that this material was inadmissible. That is the first point that does need to be made. However, the ANF is in a position, if the Commission thinks it desirable to put in some additional material on some of the basic points raised by my friend.
PN875
MUNRO J: I don't think we need to hear you further, Mr Castiglione. We will admit the material. As Mr Ellery said, it is question of what reliance may be placed on it effectively. That is a question of weight should be given to it in the final analysis. And that is a matter for submission and determination in due course on the merits. Ms Tutt, I think, is the next witness.
PN876
MS BURKE: Yes, your Honour.
PN877
PN878
MS BURKE: Ms Tutt, do you have a copy of your statement?---Yes, I do.
PN879
Okay. Your Honour, I don't have any questions for Ms Tutt. I would just like to - - -
PN880
MUNRO J: I think you should ask her to identify herself.
PN881
MS BURKE: Would you identify yourself, please?---I am the clinical - - -
PN882
PN883
MR ELLERY: Thanks, Ms Tutt. We won't keep you for very long. On your statement at paragraph 5, you refer to data collection and collation. Can you see that?---Is that point 5?
PN884
Yes, yes?---Yes.
PN885
That is on the third page?---Yes.
PN886
It says:
PN887
As the Department has no dedicated ward clerk ...
PN888
etcetera. Is that right?---Yes, yes.
**** LYNETTE ANNE TUTT XXN MR ELLERY
PN889
So is it your view that the lack of a dedicated ward clerk contributes to the workload of the nurses on that ward or that department?---In some aspects, yes. In others, no.
PN890
Yes. You refer there to collection and collation of data. And you say that is collected by nursing staff manually. I assume because there is no dedicated ward clerk. Is that right?---No. A lot of it is collected manually because it is collected at the triage desk and your registered nurse is required to triage the patients.
PN891
So what is the relevance of your statement that: "As the Department has no dedicated ward clerk" - what does that mean?---Like, when we have an admission to do, the staff gets all the information, like, their next of kin, their Medicare number, whether they are privately or publicly insured and we have a set form and that is filled out and handed over the Medical Records people. In the bigger Perth hospitals, that is all done by computer from the triage desk.
PN892
Yes, okay. I am not sure you have answered my question though. What relevance does it have, your statement, that there is no dedicated ward clerk? What difference does that make?---We do a lot of the stores ordering. Particularly after hours, because we don't have the ward clerk. We are the ones that are organising the admission.
PN893
Right?---The clerical side of the admission.
PN894
And do I take it from that, then, that if you did have a dedicated ward clerk, the ward clerk would help in some of those tasks, is that right?---They could.
PN895
Right?---I am allowed to comment to that?
PN896
If you can just answer the questions, if you could?---Okay.
**** LYNETTE ANNE TUTT XXN MR ELLERY
PN897
MUNRO J: Ms Burke will probably remind you of what it was you wanted to comment, less you be in suspense.
PN898
MR ELLERY: That is fine, thanks, Ms Tutt, nothing further.
PN899
MUNRO J: There are - what is the medical practitioner complement for the Emergency Department?---We have no resident medical officers at all in the Department. We generally have three on call and each individual one is representing a different group of general practitioners. We have an anaesthetist on call and surgeon on call.
PN900
I see. So there is a relatively continuous complement of medical - - - ?---Yes - - -
PN901
- - - staff you are supporting?---They will come in if we call them in.
PN902
And I didn't quite understand what you were putting about the way the patient reception function is carried out. You were contrasting the taking down of the material on a computer when the patient presents in some of the larger establishments. That is done by the equivalent of a ward clerk, is it?---No. At the triage desk in the big hospitals, like Royal Perth, the person - the patient gives their details to the triage nurse. That is automatically typed into a computer and that information is relayed to their clerical staff by computer cabling. And they pull up their old notes then based on their date of birth and their names. In our Department, we have to manually call for the medical record.
PN903
I see. The staffing at present is the - although I think you deal with it in paragraph 4 there. I think on the afternoon and day shift, there are three members of staff to six bays?---Yes. Plus the resus room and two consultation rooms. There is also a minor theatre.
**** LYNETTE ANNE TUTT XXN MR ELLERY
PN904
But that doesn't transpose they take it into a nurse:patient ratio, does it, or if it does, what would it be?---I couldn't answer that. It is particularly difficult because of the peak periods of activity during a 24 hour period.
PN905
Yes, well, the values don't necessarily have much to do with how many people are there at all, does it?---No, but it means you can be treating six people. Prior to our Department being redeveloped, we had three people so you could only tend to treat three people at a time.
PN906
Yes?---Whereas now we are treating six people at a time.
PN907
Well, if you have got six bays, you can treat at least the six people that are in the bays?---Yes.
PN908
Plus whoever else is coming through the door presumably?---Yes. You would have to move them around a bit. Push them down the corridor if you required a bed.
PN909
So some of the material seems to suggest that the staffing ratio for A&E is related to the number of treatment bays but it would seem that at least on my broad observation that the bays are filled and if they are not, there is a sort of queue for them?---Sorry, I didn't hear that.
PN910
Well, the bays aren't the only indicator of the total volume of throughput in an A&E section?---No.
PN911
If necessary, they are still out in the ambulances?---Yeah, or in the waiting room.
PN912
Yes, thank you.
**** LYNETTE ANNE TUTT XXN MR ELLERY
PN913
SENIOR DEPUTY PRESIDENT O'CALLAGHAN: Ms Tutt, can I ask two questions. First of all, what generally happens in the event that the emergency area is not in demand? That is, in the event that, say, for instance, you have only got one person in one of those bays?---So you are asking what - - -
PN914
Are nurses from the emergency area called upon to help in other parts of the hospital?---They can be. More frequently, though, we tend to do the non-clinical related activities, like re-stocking, cleaning, that type of thing.
PN915
Thank you?---Any quality management activities.
PN916
And, secondly, what happens if, say, two of the three registered nurses proposed for the day shift are ill? What is the process that is followed in that sort of situation?---We have - on our roster we have four casuals that are orientated and have Emergency Department experience. If they have not already been pre-booked, you ring around and ask them, then the part timers will often pick up extra shifts. And then the last resort is the full timers do overtime or double shifts.
PN917
Thank you. So there is a set process?---Yes. It very much depends on what I - as the manager, that is how I manage it.
PN918
Thank you.
PN919
MUNRO J: Ms Burke?
PN920
MS BURKE: Thank you, your Honour.
PN921
Just one question, Ms Tutt. You were about to make a comment in relation to the ward clerk issue?---Yeah. My comment to the ward clerk issue is that if we put on a ward clerk, a ward clerk can't undertake nursing activities, whereas, because we do those activities now, a registered nurse could undertake those and also have her skills used as a registered nurse when the need arose.
**** LYNETTE ANNE TUTT XXN MR ELLERY
PN922
Okay. Thank you.
PN923
Do you have any other questions? No, no. No, no further questions.
PN924
PN925
MUNRO J: Do you have any other witnesses, Ms Burke?
PN926
MS BURKE: Your Honour, we have run out of witnesses for today. We will have more available first thing in the morning, though, ready to start at 10 o'clock, if that is the - - -
PN927
MUNRO J: And do we follow the order - - -
PN928
MS BURKE: Following the order.
PN929
MUNRO J: That is Blinman and Patterson, Murphy, Clancy and McNally, or is there variation to it?
PN930
MS BURKE: Yes. No, that is the order.
PN931
MUNRO J: Will 10.15 suffice or should it be 10 o'clock? How do you think your are likely to make - - -
PN932
MR ELLERY: I am certainly confident we won't need the full day for those witnesses, your Honour, so I think there is no difficulty with 10.15.
PN933
MUNRO J: Right. Now, we have disposed of Mr Burrows, haven't we, so we don't need another video conference which is a good thing. Very well; well, we will adjourn until 10.15 tomorrow morning.
ADJOURNED UNTIL TUESDAY, 9 OCTOBER 2001 [3.50pm]
INDEX
LIST OF WITNESSES, EXHIBITS AND MFIs |
EXHIBIT #2 WITNESS STATEMENT OF KENNETH BRIAN JONES PN227
EXHIBIT #3 WITNESS STATEMENT OF BELINDA KATE MORIESON PN228
EXHIBIT #4 WITNESS STATEMENT OF LYNETTE TUTT PN228
EXHIBIT #5 WITNESS STATEMENT OF LORETA VERONICA MURPHY PN228
EXHIBIT #6 WITNESS STATEMENT OF PEGGY BRIGGS PN228
EXHIBIT #7 WITNESS STATEMENT OF STUART BLINMAN PN228
EXHIBIT #8 WITNESS STATEMENT OF MURDO MacKAY LEE PN228
EXHIBIT #9 WITNESS STATEMENT SEAN FINCH PN228
EXHIBIT #10 WITNESS STATEMENT WITH ATTACHMENT, PN228
EXHIBIT #11 WITNESS STATEMENT WITH ATTACHMENT, PN228
EXHIBIT #12 WITNESS STATEMENT OF RAYE McNALLY PN228
EXHIBIT #13 WITNESS STATEMENT OF JACQUELINE FARRINGTON PN228
EXHIBIT #14 WITNESS STATEMENT OF MICHAEL CLANCY PN228
EXHIBIT #15 WITNESS STATEMENT OF DEREK PATERSON PN228
EXHIBIT #16 WITNESS STATEMENT OF SALLY TOWIE PN228
EXHIBIT #17 WITNESS STATEMENT OF LEANDA VERRIER PN228
EXHIBIT #18 WITNESS STATEMENT OF ANNE HELENA FOYER PN228
EXHIBIT #19 ANF ALTERNATIVE DRAFT ORDER 1 PN228
EXHIBIT #20 ANF ALTERNATIVE DRAFT ORDER 2 PN228
EXHIBIT #21 ANF ALTERNATIVE DRAFT ORDER 3 PN228
EXHIBIT #22 WITNESS STATEMENT AND ATTACHMENTS, ROBERT MAXWELL BURROWS PN228
EXHIBIT #23 SUPPLEMENTARY WITNESS STATEMENT AND ATTACHMENTS, KENNETH BRIAN JONES PN228
EXHIBIT #ANF24 ANF OUTLINE OF SUBMISSIONS RECEIVED ON 13 JULY PN233
EXHIBIT #ANF25 ANF CONTENTIONS IN REPLY TO THE WAGHI SUBMISSIONS LODGED ON 7 SEPTEMBER PN234
EXHIBIT #WAGHI1 FOLDER 1 PN255
EXHIBIT #WAGHI2 FOLDER 2 PN256
EXHIBIT #WAGHI3 OUTLINE OF SUBMISSIONS IN REPLY PN258
EXHIBIT #WAGHI4 SUPPLEMENTARY WITNESS STATEMENT OF CHRISTINE O'FARRELL PN259
EXHIBIT #LHMWU1 OUTLINE OF SUBMISSIONS LODGED ON 8 AUGUST PN263
EXHIBIT #LHMWU2 WITNESS STATEMENT OF JANE REED PN264
EXHIBIT #WACCI1 SUBMISSION OF CHAMBER OF COMMERCE AND INDUSTRY LODGED ON 15 AUGUST PN265
EXHIBIT #HSOA2 OUTLINE OF SUBMISSIONS PN266
BELINDA KATE MORIESON, AFFIRMED PN367
EXAMINATION-IN-CHIEF BY MS BURKE PN367
CROSS-EXAMINATION BY MR ELLERY PN372
RE-EXAMINATION BY MS BURKE PN468
WITNESS WITHDREW PN471
ROBERT MAXWELL BURROWS, SWORN PN473
EXAMINATION-IN-CHIEF BY MS BURKE PN473
CROSS-EXAMINATION BY MR ELLERY PN484
RE-EXAMINATION BY MS BURKE PN520
WITNESS WITHDREW PN524
KENNETH BRIAN JONES, SWORN PN561
EXAMINATION-IN-CHIEF BY MS BURKE PN561
CROSS-EXAMINATION BY MR ELLERY PN567
RE-EXAMINATION BY MS BURKE PN850
WITNESS WITHDREW PN864
LYNETTE ANNE TUTT, AFFIRMED PN878
EXAMINATION-IN-CHIEF BY MS BURKE PN878
CROSS-EXAMINATION BY MR ELLERY PN883
WITNESS WITHDREW PN925
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