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Australian Industrial Relations Commission Transcripts |
TRANSCRIPT OF PROCEEDINGS
Workplace Relations Act 1996 18954-1
DEPUTY PRESIDENT HAMILTON
C2008/69
s.170LW - prereform Act - Appl’n for settlement of dispute (certified agreement)
Health Services Union
and
Barwon Health
(C2008/69)
MELBOURNE
10.28AM, TUESDAY, 12 AUGUST 2008
PN1
MS L SVENDSEN: I appear on behalf of the Health Services Union with
MR W WATTS, an organiser with the Health Services Union.
PN2
MR R CORBOY: I'm from the VHIA, representing Barwon Health who is a member of our association with MR P DUNN also from Barwon Health.
PN3
THE DEPUTY PRESIDENT: Written submissions have been filed and there are some eight witnesses, is it? Yes?
PN4
MS SVENDSEN: Yes, your Honour.
PN5
THE DEPUTY PRESIDENT: How are we going to deal with that? What I propose to do is hear the witnesses first and then submissions. Secondly, if there's no cross-examination proposed, one course of action to save time, would be to simply admit the witness statement into evidence. Is there cross-examination of all the witnesses or not?
PN6
MS SVENDSEN: I think, your Honour, there is, although not terribly much.
PN7
THE DEPUTY PRESIDENT: You have a day to get through eight witnesses. I don't see how I'm going to get through eight witnesses in a day if you're all going to cross-examine.
PN8
MS SVENDSEN: I think the cross-examination is not extensive from either of us and we have actually had a brief discussion. Both of us are happy to admit the witness statements with any clarification and then any minor additions to those statements, where required.
PN9
THE DEPUTY PRESIDENT: All right, so there will be cross-examination. I might add, in one case at least, the VHIA witness statement, I'm not sure a lot of that is actually evidence. I mean, it seems to be more of a submission but anyway, we'll come to that if necessary. I don't like to hear evidence about interpretation of agreements and things of that nature. That's more in the nature of submissions usually, but we'll see.
PN10
MR CORBOY: Excuse me, your Honour, there is a matter which I did foreshadow with your associate yesterday.
PN11
THE DEPUTY PRESIDENT: You have to leave by lunchtime. How do you propose to get through eight witnesses by leaving at lunchtime, out of interest?
PN12
MR CORBOY: No. I have moved my meeting till 3.30 so I think 2.30, quarter to three would be the timeframe.
PN13
THE DEPUTY PRESIDENT: Will we get through eight witnesses in time, do you think?
PN14
MR CORBOY: I would hope so, because my cross-examination will be fairly specific on each one.
PN15
THE DEPUTY PRESIDENT: That is a relief. I've heard many cases where I was assured something of that nature, only to find that we are there for three days rather than one. Nevertheless, I take you at your word. Thank you very much.
PN16
MR CORBOY: I hope not. Your Honour, there is another matter, there are witnesses in the back of the court. I've advised my witnesses that they will be excluded, save for Mr Dunn who is here to instruct me, but that's in the Commission's hands.
PN17
THE DEPUTY PRESIDENT: I think that's quite appropriate. Unless there's an objection to that I'd ask that all witnesses giving evidence today leave the courtroom, please. It's always a good thing to remind the other party of that.
PN18
MR CORBOY: Just one final thing, your Honour, Ms Svendsen and I have had a discussion that should we be time compressed she has agreed, if the Commission allows it, to do written submissions which would enable the parties to just focus on the witness evidence today.
PN19
THE DEPUTY PRESIDENT: I don't usually have a problem with written submissions but we'll try and get through it all today if we can. What I'd like to do is start with a brief statement, a couple of paragraphs, from each side about the nature of their case, if that would be all right, starting with you, Ms Svendsen, is that's all right. Just a few paragraphs, nothing too strenuous.
PN20
MS SVENDSEN: Nothing too strenuous, thank you, your Honour. This is application under 170LW of the pre-reform Act in relation to the application of clause 21.15, the seniors' allowance under the Victorian Psychiatric Services Certified Agreement 2004-2007.
PN21
THE DEPUTY PRESIDENT: 21.5?
PN22
MS SVENDSEN: 21.15, your Honour.
PN23
THE DEPUTY PRESIDENT: I have it.
PN24
MS SVENDSEN: The application of the seniors' allowance, as it relates to
three psychiatric state enrolled nurses, level 2, from Barwon Health, they being Rosemary Kallasmae, Jenny Watts and Sandra Watts.
PN25
THE DEPUTY PRESIDENT: So there's three people?
PN26
MS SVENDSEN: Three people.
PN27
THE DEPUTY PRESIDENT: You say they meet the requirements of 21.15.
PN28
MS SVENDSEN: We contend they meet the requirements of 21.15 and should in fact granted a seniors' allowance and that the date of application should be backdated to the date that they made their application to Barwon Health for that seniors' allowance.
PN29
THE DEPUTY PRESIDENT: You rely on the decision of Commissioner Cribb as to the meaning of the words "net addition to the work value of the substantive role." Is that right?
PN30
MS SVENDSEN: I do.
PN31
THE DEPUTY PRESIDENT: Is that decision agreed by both sides?
PN32
MR CORBOY: It is a decision that's been made by Commissioner Cribb when Commissioner Cribb was looking at the instrument technicians involved in that particular matter. We will be relying upon that in our submissions as well.
PN33
THE DEPUTY PRESIDENT: There's no disagreement as to the contents of that decision.
PN34
MR CORBOY: We'll also draw the Commission's attention to Commissioner Blair when he made his decision - - -
PN35
THE DEPUTY PRESIDENT: You don't disagree with, for example, paragraph 12 of their submission, do you?
PN36
MR CORBOY: Paragraph 12 of the union submissions?
PN37
THE DEPUTY PRESIDENT: Yes, which purports to summarise the effect of Commissioner Cribb's decision, in other words, extrapolates the meaning of the words - - -
PN38
MR CORBOY: No, we actually disagree with that particular context.
PN39
THE DEPUTY PRESIDENT: You do disagree with it.
PN40
MR CORBOY: Yes.
PN41
THE DEPUTY PRESIDENT: I thought you might.
PN42
MR CORBOY: We will be relying upon the conclusion of Commissioner Cribb's decision.
PN43
THE DEPUTY PRESIDENT: In a sentence, where is the disagreement with that aspect of Commissioner Cribb's decision?
PN44
MR CORBOY: The disagreement exists in clause 94.
PN45
THE DEPUTY PRESIDENT: Of what?
PN46
MR CORBOY: It says here:
PN47
Having assessed the three employees against the criterion basis that all the criterion must be met to qualify for the seniors' allowance.
PN48
We will be focusing on - - -
PN49
THE DEPUTY PRESIDENT: Clause what?
PN50
MR CORBOY: Clause 94 of the Commissioner's decision.
PN51
THE DEPUTY PRESIDENT: Yes, what about it?
PN52
MR CORBOY: Commissioner Cribb points out that all the criteria must be met to qualify for the seniors' allowance. As your Honour would be aware, the seniors' allowance has got a number of criteria which have to be met and we'll be linking that to the Commissioner's conclusion, that all the criteria, not some, have to be met to actually qualify for the seniors' rate.
PN53
THE DEPUTY PRESIDENT: That's not agreed. Is that right?
PN54
MR CORBOY: In reading the union's submission, it would appear that they don't rely on all the criteria being met and that's why Commissioner Cribb in her decision indicated that two people did not meet the criteria but one person did.
PN55
THE DEPUTY PRESIDENT: That's the extent of the disagreement.
PN56
MR CORBOY: As far as Commissioner Cribb's decision, yes.
PN57
THE DEPUTY PRESIDENT: Thank you very much for that. Sorry to interrupt you, Ms Svendsen.
PN58
MS SVENDSEN: That's quite all right.
PN59
THE DEPUTY PRESIDENT: Do you agree that every criterion must be met?
PN60
MS SVENDSEN: We do.
PN61
THE DEPUTY PRESIDENT: You're in agreement then.
PN62
MS SVENDSEN: Yes. It may well be a synopsis that I have used and I admit that there are four dot points rather than five, for instance, that it doesn't expand upon it in quite the way that - but yes, I agree that all the criteria should be met and that's what we will be going to.
PN63
THE DEPUTY PRESIDENT: Thanks for that. Do you agree that all the criteria are met - I'm sorry, have you finished, Ms Svendsen, your summary?
PN64
MS SVENDSEN: Yes, I'm fine, thank you.
PN65
THE DEPUTY PRESIDENT: Mr Corboy, do you agree that - which of the criteria are not established with the three employees in this case?
PN66
MR CORBOY: There are a number of the criteria and unfortunately, I'll have to take them through that.
PN67
THE DEPUTY PRESIDENT: The three employees are who?
PN68
MR CORBOY: Sandra Watts, Jenny Watts and Rosemary Kallasmae.
PN69
THE DEPUTY PRESIDENT: Sandra Watts, which criteria does she meet and which doesn't she? Just get it out if we could, just in a paragraph so we have it in front of us.
PN70
MR CORBOY: Sure. With Sandra Watts there is the ongoing requirement that she is working beyond the scope of - - -
PN71
THE DEPUTY PRESIDENT: Sorry, which one is this? I have the clause 21.15 in front of me. Ms Watts, which does she not meet. Commissioner
Cribb's
four issues which seem to be different by an extrapolation of the opening words.
PN72
MR CORBOY: This will be addressed by our witnesses comprehensively.
PN73
THE DEPUTY PRESIDENT: No, no, I'm sure that is, but which does Ms Watts meet and which doesn't she meet?
PN74
MR CORBOY: We would contest that she does not meet the requirements of working beyond the scope of practice of a PSEN2 which has
got a definition contained within the award. We would contend she does not work beyond the scope of practice of a PSEN2 as understood
- evidence will be given regarding the Nurses Board. We don't agree that she has additional functions which are a regular and ongoing
requirement. We do concede there may have been some on the job training but, however, this is part of all employees in the nursing
division.
Ms Watts refers to a number of things like fire training and things like that.
PN75
Additional training aspect of the role, we would contend this is ongoing education applicable to all registered nurses and is an expectation of the Nurses Board. A greater level of judgment, we would believe that they're operating within the scope of their job description in the PSEN2 duties as contained within the - - -
PN76
THE DEPUTY PRESIDENT: Okay, so there was no greater level of judgment. Go on.
PN77
MR CORBOY: We don't believe that they have a higher accountability - - -
PN78
THE DEPUTY PRESIDENT: The only one she meets is experience, in your view.
PN79
MR CORBOY: They are all experienced. There's no question about that.
PN80
THE DEPUTY PRESIDENT: Sorry, 21.15B(ii).
PN81
MR CORBOY: They are all experienced as such.
PN82
THE DEPUTY PRESIDENT: All of them meet that?
PN83
MR CORBOY: As far as I'm aware, yes.
PN84
THE DEPUTY PRESIDENT: That's fine.
PN85
MR CORBOY: They have some 20 years' experience so they are
experienced - - -.
PN86
THE DEPUTY PRESIDENT: Is it the same with the other two employees?
PN87
MR CORBOY: Yes, they are experienced.
PN88
THE DEPUTY PRESIDENT: No, no, you've just said that Ms Watts doesn't meet any of the criteria other than 21.15B(ii). Are the other employees in the same position or not?
PN89
MR CORBOY: Yes, they are, your Honour.
PN90
THE DEPUTY PRESIDENT: It's all the same.
PN91
MR CORBOY: Yes, and I may draw your Honour's attention to 21.5(v) the higher level of accountability, we would contend that that is within their job description and scope as that is contained within the EBA and the Nurses Board. So they are operating at a higher level but that's expected within a particular industrial instrument.
PN92
THE DEPUTY PRESIDENT: Thank you very much for that. With that outline, perhaps we could start the witness evidence, if that would be all right, starting with Ms Svendsen.
PN93
MS SVENDSEN: Your Honour, I would actually call Denise Guppy first.
THE DEPUTY PRESIDENT: I'm sorry to move these things along briskly, but we do have a job to do.
<DENISE FAYE GUPPY, AFFIRMED [10.41AM]
<EXAMINATION-IN-CHIEF BY MS SVENDSEN
PN95
MS SVENDSEN: Denise, can you make sure you talk towards his Honour and into the microphone so the transcript reader can hear you properly, please.
PN96
Your Honour, we tender Ms Guppy's statement as written and the attachments that we have provided already to the Commission.
THE DEPUTY PRESIDENT: There's so many documents I can't actually find it at the moment. It's not in order. No criticism there. I have it thanks.
EXHIBIT #HSU1 WITNESS STATEMENT OF DENISE FAYE GUPPY
PN98
MS SVENDSEN: Given that we're actually trying for brevity today, I would actually ask the Commission whether or not - - -
PN99
THE DEPUTY PRESIDENT: If it's in the witness statement, there's no need to repeat it.
PN100
MS SVENDSEN: No, I wasn't going to. I was actually wondering whether there was a necessity - Ms Guppy has given a potted history of how the classification standards, the PSEN2 standards came from the Public Service determination into the current agreement. If that's fine, I will leave it at that and let Mr Corboy cross-examine.
PN101
THE DEPUTY PRESIDENT: History of that nature may not be appropriate for - that's more of a submissions matter, isn't it? I might be wrong.
PN102
MS SVENDSEN: I'm fine with it at that. Thank you.
PN103
THE DEPUTY PRESIDENT: If it's in there, that's fine.
MS SVENDSEN: It is.
<CROSS-EXAMINATION BY MR CORBOY [10.44AM]
PN105
MR CORBOY: Ms Guppy, do you have your statement before you?---I do.
PN106
Clause 13, may I direct you to that, please?---Yes.
PN107
In clause 13 there you detail the fact there are medication endorsement, psychiatric endorsement and preceptorship?---That's right.
**** DENISE FAYE GUPPY XXN MR CORBOY
PN108
The medication endorsement, can you advise the Commission whether that's within the scope of practice of the Nurses Board, division 2 Nurses Board - for a division 2 nurse?---Yes, it is in the scope of practice.
PN109
Psychiatric endorsed. Is that within the scope of practice of a division 2 psychiatric nurse?---Yes, it is.
PN110
The preceptorship, this is really something of the individual employer, is it not?
---Can you explain that question, sorry.
PN111
The preceptorship of division 1 nurses, you believe that goes beyond the scope of a PSEN2?---I do believe it goes beyond the scope of - - -
PN112
Do you believe they're operating beyond the scope as specified within the Nurses Board?---No. I think that it's something that adds
value to the situation on a unit and assists with training support for new employees, students, coming into a unit and I believe
that the skills that the individuals we're talking about have been developed to a point that they can actually preceptor division
1 nurses, that's
three year trained nurses. Because of their experience and because of the education that they've participated in they're able to
do that. It's unusual and some mental health services do do that. Some SEN2s aren't at an advanced stage and don't have those advanced
skills to actually be able to do that. It does occur in other mental health services but it's quite - it is unusual in terms of
the profession and new.
PN113
It's not unique to Barwon, from what you've just said?---No, it's not unique to Barwon.
PN114
Within this role of preceptorship, correct me if I'm wrong, they would undertake that within the scope as outlined by the Nurses Board of Victoria?---Within their scope as a division 2 nurse, yes.
PN115
What they're doing is, they're utilising their experience as a division 2 nurse to assist people into orientation or to work in the
ward, who are new to the ward?
---To work in - specifically in mental health. I mean, I think what we have to remember is that the division 2 nurses, and why
we're here, is that these nurses work in an acute adult mental health unit.
PN116
Are you aware of any limitations in this role of preceptor, that the ..... has any limitations as different to a div 1 or div 3?---Limitations in terms of what they might work with, do you mean?
**** DENISE FAYE GUPPY XXN MR CORBOY
PN117
Evidence will be given to the Commission that a div 2 preceptor cannot sign off the training for a student, for a div 1 student and they cannot sign off on a number of things because of the div 1 registration requirements for training?---Yes.
PN118
Are you aware that evidence is going to be given to the Commission?---No, I'm not aware of that. What I would say about that is that there are processes that deal with a sign-off for the training of student nurses and division 1 nurses who might be being orientated. There are formal processes in terms of the requirements in terms of students that are required - there are formal education processes that are required by the university and by the workplace to ascertain if a student has actually passed their placement. In terms of preceptorship, it’s a new concept, it's a new process and additionally, the SENs would be working alongside the student to achieve the outcomes of their placement, but they would also be doing a range of things that are really important to mental health practice in terms of orientating about a whole ward environment, acuity of ward, processes within the particular unit specific to mental health, processes that occur within the ward in terms of managing a disturbed client and other parts of professional practice in mental health and they would be working under the direction, as all SENs do, of a div 3. I think the sign-off is a technicality that's required but there are other issues that occur within a mental health unit that don't require that technical sign-off.
PN119
A PSEN reports to a div 1 or div 3?---That's right.
PN120
Works under the supervision of a div 1 or div 3?---That's right.
PN121
Therefore, it's more than just a technicality about sign-off on training because a div 1 or div 3 has the responsibility?---Absolutely, yes.
PN122
In your evidence you said that they would be there for orientation and processes in the ward or processes for dealing with issues,
right? This would surely - - -?
---Sorry, and I should add, of course, the care of the client.
PN123
This would surely be covered by the policy and procedure of the organisation?
PN124
THE DEPUTY PRESIDENT: Sorry, say that again. I missed that.
PN125
MR CORBOY: Sorry. What you're talking about is it normal practice that would be covered by policy and procedure of the organisation?---In terms of orientation?
**** DENISE FAYE GUPPY XXN MR CORBOY
PN126
Orientation and dealing with difficult patients and how to respond to certain things?---There are policies and procedures. I think the important part of mental health practice and psychiatric nurse practice doesn't sit in a policy or a procedure, it's supported by that. It is about the person, it's the skills, the knowledge, the attitude that an individual nurse will engage with a student or a new employee to do that. Yes, they're supported - practice is supported by policies and procedures standards and they're outlined in evidence, as I understand. Policies and procedures support practice but they don't actually deal with the one to one relationship, skills, knowledge and attitude of particular individual practising nurses.
PN127
Just referring back to 13, the medication or the psychiatric endorse, is this recognised in the award or the EBA in any other way? Is there an allowance that's paid for that? Is there a medication allowance?---There isn't actually a medication allowance but there's a qualification allowance.
PN128
There's a qualification allowance?---Yes.
PN129
So that's payable there. I am aware of your position with the union but I'm going to ask a question. Have you observed these nurses in the workplace undertaking their role?---No, I have not observed them in the workplace undertaking their role.
PN130
That's all, your Honour.
PN131
THE DEPUTY PRESIDENT: Any re-examination?
MS SVENDSEN: There is, your Honour.
<RE-EXAMINATION BY MS SVENDSEN [10.52AM]
PN133
MS SVENDSEN: Denise, you spoke of practice of a division 2 nurse under the Nurses Board Regulations and the Australian Nursing and Midwifery Council Standards. Is that broader than the PSEN2 classification description out of the agreement?---I would say that those things are broader than the classification standards in the agreement, the classification standards - and there's a historical outline of that. They were, you know, developed and have been around since 1986 and I think practice has expanded the requirements of the way in which individual nurses practise. I think there's more required of practising nurses and they're not - I don't believe that's reflected in the classification standards, but certainly, in terms of the competent - National Competency Standards, also the National Mental Health Workforce Standards, I think they outline in much greater detail the role and function, as opposed to the class standards, which is, I guess, a statement about the requirement to update those classification standards, possibly.
**** DENISE FAYE GUPPY RXN MS SVENDSEN
PN134
THE DEPUTY PRESIDENT: There is a difference between the agreement classification standards. Is that what you're referring to?---I am.
PN135
And the what?---The National Competency Standards for enrolled nurses, also the national standards for the mental health workforce.
PN136
You're saying that the agreement classification definitions have lagged somewhat, have they?---Yes.
PN137
In what area?---I think in the actual - in the scope of practice about actually what people do on a daily basis and the development of the scope of practice. I think there's a difference between the Nurses Board descriptors of the scope of practice and, you know, there's no reflection in the classification standards of medication endorsement and there's no reference to activities specifically around preceptorship and the sorts of things that people are doing and I think that's sometimes the disagreement that we have with employers.
PN138
I have to have regard to the agreement classifications, don't I? That's the relevant document for interpreting 21.15, isn't it?
PN139
MS SVENDSEN: We certainly would argue so, your Honour.
PN140
THE DEPUTY PRESIDENT: You would argue so?
PN141
MS SVENDSEN: Definitely.
PN142
THE DEPUTY PRESIDENT: Why am I hearing about other documents?
PN143
MS SVENDSEN: The question that Mr Corboy asked in relation to scope of practice was about the Nurses Board scope of practice and the Nursing and Midwifery Council scopes of practice and whether the PSENs were currently acting within that scope of practice.
PN144
THE DEPUTY PRESIDENT: Yes, I do remember. Your view is we look to the classification, their view is we look to other documents in addition. Is that - - -
PN145
MS SVENDSEN: I'm sorry?
PN146
THE DEPUTY PRESIDENT: I'm sorry, I'm engaging in a debate but I don't follow some of this. I'm sure it will all be crystal clear by the end of today.
**** DENISE FAYE GUPPY RXN MS SVENDSEN
PN147
MS SVENDSEN: Hopefully, it will all be crystal clear by the end of the day.
PN148
THE DEPUTY PRESIDENT: That was a joke.
PN149
MR CORBOY: Would it assist the Commission if we excused the witness and perhaps I address the Commission.
THE DEPUTY PRESIDENT: That would be useful. Thank you very much. Would you excuse us for a minute. I do apologise to the parties for raising these issues but I was getting extremely confused.
<THE WITNESS WITHDREW [10.56AM]
PN151
MR CORBOY: Your Honour, within Victoria nurses operate under a registration under the Nurses Act Victoria and within that registration the Nurses Board of Victoria publishes a scope of practice, in other words what each division of registered nurse can operate, the range of duties and function in which they can operate. The Nurses Board has got effectively four divisions, division 1, which is your three year trained nurse, division 2 is your SEN or your PSEN who will be covered by that particular registration. Then you have division 3 which is your specifically registered psychiatric three year trained nurse. They're often called RPN, and division 5 which is a mothercraft nurse.
PN152
THE DEPUTY PRESIDENT: Those are the levels.
PN153
MR CORBOY: Those are the levels. Now, each person has to maintain their registration and register with the board to be able to practice so the board issues, in conjunction with the Australian Nursing Council a scope and also a code of conduct. Conduct is not in question here today but we are talking about scope so any nurse, we would contend, would have to answer to their registration to the Nurses Board. The industrial instrument is there but their registration is predicated upon their scope of practice as outlined by the Nurses Board.
PN154
THE DEPUTY PRESIDENT: In interpreting clause 21.15 and the tests there, is it work value in excess of that set out in the agreement classifications or is it work value in excess to that set out in the Nurses Board code of conduct or documents or both or neither?
PN155
MR CORBOY: It would be both, we would contend, your Honour, because there is an expectation that a div 2 nurse, if I may call them that, PSEN or SEN would operate within their scope and they'd operate within a level in the organisation which is covered by that - - -
PN156
THE DEPUTY PRESIDENT: Are these documents referred to in the agreement?
PN157
MR CORBOY: They are not referred to in the agreement but it is a requirement that they operate at that level, otherwise they can't be registered nurses. If they go beyond the scope then they're up for sanction by the Nurses Board.
PN158
THE DEPUTY PRESIDENT: I see.
PN159
MS SVENDSEN: If it will assist the Commission, Mr Corboy is right, there are sanctions, they can lose their practising certificate if they operate beyond their scope of practice. We contend that the classification standards are what we measure against and not the scope of practice issued by the Nurses Board which are in conjunction with the Australian Standards which come from the Nursing and Midwifery Council.
PN160
We would also say that the reason we contend that the classification standards are relevant is that the scope of practice applies
for enrolled nurses per se. We have two levels of enrolled nurse under our agreement, PSEN level 1 and PSEN
level 2. The scope of practice for a registered nurse division 1 or division 3 also is a broad scope of practice. We have seven
levels of registered nurse division 1-3 from grade 1 through to grade 7.
PN161
The scope of practice of a grade 1 division 1 nurse is nowhere near the scope of practice of a grade 3, a grade 4, et cetera and ditto the scope of practice of a PSN1 that they are actually allowed to operate within because of the level of their expertise.
PN162
THE DEPUTY PRESIDENT: I'm puzzled, because if you go beyond your scope of practice you lose your registration so how can you say that you're operating net addition to the scope of practice? That's not the test, though, is it?
PN163
MS SVENDSEN: We say it's not the test, it's the classification standards within the agreement that is the test, not the scope of practice which actually covers the range of all registered nurses that fit within that particular division.
PN164
THE DEPUTY PRESIDENT: Thanks very much. Anyway, if those documents are relevant I'll need to see them so if they haven't been provided, they could be.
PN165
MR CORBOY: Certainly, your Honour.
PN166
THE DEPUTY PRESIDENT: If people are relying on them I'll need to see them.
PN167
MR CORBOY: Yes. Just a point of clarity, on the information that I received, Denise Guppy has got a number of attachments with her statement so I'll be taking the witness to that attachment.
PN168
THE DEPUTY PRESIDENT: Has she? Well, my document hasn't got that.
PN169
MR CORBOY: If not, I have extracts from the particular EBA.
PN170
THE DEPUTY PRESIDENT: None of this is organised in folders. I have, I think, five different documents provided by email, fax so I'll organise it myself.
PN171
MR CORBOY: Your Honour, I'll be taking the witnesses - if we can't use Ms Guppy's statement and the attachments, even though they were included in the emails or facsimiles, I will be handing up copies out of the EBA for definition purposes.
THE DEPUTY PRESIDENT: Thanks. Let's get back to the re-examination stage so we'll bring back the witness.
<DENISE FAYE GUPPY, RECALLED ON FORMER AFFIRMATION [11.02AM]
THE DEPUTY PRESIDENT: I remind you you're still on oath. Ms Svendsen, re-examination.
<RE-EXAMINATION BY MS SVENDSEN, CONTINUING [11.02AM]
PN174
MS SVENDSEN: Denise, do you recall when the medication endorsement for PSENs became available as a course, roughly?---Roughly, it's
rough, two or
three years possibly.
PN175
The division 2 mental health post graduate course?---Leigh, you're stretching my memory, two or three years.
PN176
Neither of those things were envisaged when the classification standards were written, would you say?---You're stretching my memory again. Look, certainly not different, you know the class standards developed - been around since 1986. I'm not sure that anybody could have foreseen what would happen in the health services and what would happen in terms of the workforce.
PN177
With preceptorship of nursing students, be they division 1 or division 2, which they weren't called at that time, were division 1 and 2 nurses around in 1986, to your memory?---Not in a formalised structure. It was very - an informal process and it wasn't determined by any learnings either. It wasn't supported by learning and formalised courses to support that process. It just happened ad hoc informally if somebody probably could be bothered doing it. Good nurses did it, other nurses didn't do it.
PN178
THE DEPUTY PRESIDENT: This is re-examination, is it?
PN179
MS SVENDSEN: That's all, thank you, your Honour.
PN180
THE DEPUTY PRESIDENT: I did ask questions during the re-examination, so any issues arising out of my questions?
MR CORBOY: Your Honour, there was a matter which I suppose was explored in re-examination.
<FURTHER CROSS-EXAMINATION BY MR CORBOY [11.05AM]
PN182
MR CORBOY: Ms Guppy, the medication endorsement, are you aware that it's been in other states for SENs?---Am I aware? I don't know if I'm aware.
**** DENISE FAYE GUPPY FXXN MR CORBOY
PN183
Thank you, your Honour.
THE DEPUTY PRESIDENT: Thank you for giving evidence, you're excused.
<THE WITNESS WITHDREW [11.05AM]
PN185
THE DEPUTY PRESIDENT: Next witness, Ms Svendsen. Who's the next one you want to call? What's the order, by the way?
PN186
MS SVENDSEN: Jenny Watts, your Honour.
PN187
THE DEPUTY PRESIDENT: So it goes Denise Guppy, then Jenny watts, then who?
PN188
MS SVENDSEN: Sandra Watts.
PN189
THE DEPUTY PRESIDENT: Then?
PN190
MS SVENDSEN: Rosemary Kallasmae.
PN191
THE DEPUTY PRESIDENT: Then Sid Pope?
PN192
MS SVENDSEN: Then Sid Pope.
THE DEPUTY PRESIDENT: That's the order, thanks, I've got that. Now it's Jenny Watts.
<JENNY LYNN WATTS, AFFIRMED [11.07AM]
<EXAMINATION-IN-CHIEF BY MS SVENDSEN
PN194
MS SVENDSEN: Jenny, if you could actually address your responses to his Honour and speak into the microphone so that the transcript writer can hear you properly. Your Honour we're tendering Jenny's statement in evidence.
PN195
THE DEPUTY PRESIDENT: Just ask her if it's true and correct, if that's all right.
PN196
MS SVENDSEN: You've read your statement, you've got a copy before you?
---Yes, I have.
PN197
Is this true and correct?---Yes, this is true and correct.
PN198
THE DEPUTY PRESIDENT: You're tendering it?
PN199
MS SVENDSEN: We are. I actually, your Honour, will tender the exhibits marked more easily for your - - -
THE DEPUTY PRESIDENT: Thank you very much.
EXHIBIT #HSU2 WITNESS STATEMENT OF JENNY LYNN WATTS
PN201
THE DEPUTY PRESIDENT: Those are her attachments, are they?
PN202
MS SVENDSEN: They are, your Honour.
PN203
THE DEPUTY PRESIDENT: I see, okay. If you don't need them, thank you.
PN204
MS SVENDSEN: Jenny, could you go through the sort of work that you do on a daily basis?---At the commencement of my shift, we have a handover in which the patients, clients - what has happened in the previous shifts is handed over to us and we are then allocated patients, generally of about five, sometimes four, depending on the number of patients on the ward. Once that is allocated, then my first duty is to go and make sure that they're all present and accounted for and that they are all safe and from then on I read the previous notes from the night before and administer any medications that are needed to those clients, prepare them for the day, inform them about the day's events. That often includes doctors' rounds, when they should possibly be happening. I will consult with the shift manager whether there might be any specific issues, problems or any specific duties they would also like me to undertake for that day with regard to the clients that I have. I ensure that everybody is up and about, having their meals, assisting them with their ABL skills. From then - and at the same time assessing their current mental state and by doing that we do what we call a mental state examination and we're often doing that throughout the shift and that involves assessing the person's current mental state. I will also at some stage during the shift - - -
**** JENNY LYNN WATTS XN MS SVENDSEN
PN205
Can I just interrupt there. Doing a mental state examination, can you actually give us some information about the importance of a
mental state exam please, Jenny?
---Yes, I can. A mental state examination is very important because it helps assess and also predict - help to predict a person's
mental state at the time when you are dealing with them, whether they are suffering from any perceptual difficulties, whether they're
actually orientated at the time. It assesses their behaviours, it assesses their intellectual capacity and their ability to comprehend
what is being told to them. It is something that is used by all the staff and psychiatrists at the time and it denotes a person's
or patient's level of wellbeing at that time.
PN206
THE DEPUTY PRESIDENT: This is background information, is it?
PN207
MS SVENDSEN: Yes, your Honour.
PN208
THE DEPUTY PRESIDENT: Not specifically on any of the tests that have to be met.
PN209
MS SVENDSEN: This actually will go to some of the tests in fact.
PN210
THE DEPUTY PRESIDENT: Okay. Go ahead.
PN211
THE WITNESS: It then leads me to also do what we call a - I'm sorry, I've forgotten the word - risk assessment which then denotes a patient's level of risk pertaining to their risk of self harm, suicide, their level of risk with harm to others and a risk assessment is done on every shift and - - -
PN212
MS SVENDSEN: Who undertakes that, Jenny?---I do. Your Honour, I do a risk assessment on my clients on every shift.
PN213
Does anybody else undertake that with you?---The medical officer has a duty to perform that with me and if the medical officer is not available, then it is the shift leader - shift manager.
PN214
It's always undertaken in conjunction with the shift manager?---Yes, well, with either the shift manager or the medical officer.
PN215
The mental state exam is undertaken by whom?---Is often undertaken by myself, your Honour.
**** JENNY LYNN WATTS XN MS SVENDSEN
PN216
Alone?---Yes.
PN217
What are the risks of getting those wrong?---The risks of getting those wrong could lead to sometimes the patient may well suicide, a patient may well abscond, a patient could be at risk of harm to others. It is my responsibility to anticipate - assess and anticipate and hopefully foresee and act upon, prevent those things from happening.
PN218
You've undertaken your mental health post basic training?---Yes, I have.
PN219
How does that inform the work in terms of risk assessment in mental state examination?---I'm sorry?
PN220
How did that inform the work that you do in risk assessment change what you do or the way you undertook that?---The mental health course enhanced my abilities to assess further, more clearly the clients that I look after.
PN221
Jenny, can you tell us what things you undertake at work that aren't done by other psychiatric state enrolled nurses in the unit?---I administer medications to my clients and, as I've said before, I can assess their mental state examinations and will report to the shift manager and we will discuss the possibilities of my clients needing extra medications or the possibilities of taking other preventative measures to - other measures to make sure that they are safe and that the unit is safe. I attend - well, I give a verbal handover to teams out in the community every morning via the telephone and that informs the community teams as to the current happenings of my clients, where they are at and the position of the ward generally. I go into meetings with the psychiatrist and other community team members. We - together as a team, we are involved in discharge planning, current management statuses for patients on the ward, educate. I do a lot of education with my clients with regard to their illnesses, et cetera, and to medications, their choices and often act as a advocate for my clients on the ward.
PN222
Can you talk about your role as a preceptor of students?---As a preceptor of students on the unit, when a student first comes to the unit and they're orientated on the unit and they're allocated to a team, and I'm a member of a team, students will be told that they will be assigned to that team and as a preceptor, the student will then accompany me with my duties and observe my duties with my clients and they are then encouraged to individually, under actually my supervision, look after certain clients, a number of clients on the ward. I educate my students very - a considerable amount of the time. I also encourage them to make decisions for themselves. I sign off on their - I countersign their notes, their nursing notes and also educate them on all parts of mental illness and I countersign their - and supervise their medication practices.
**** JENNY LYNN WATTS XN MS SVENDSEN
PN223
Thank you, that's all for the moment.
THE DEPUTY PRESIDENT: Any cross-examination?
<CROSS-EXAMINATION BY MR CORBOY [11.20AM]
PN225
MR CORBOY: Ms Watts, do you have your witness statement before you?
---Yes, I do.
PN226
I just want to take you to a couple of areas in that witness statement. Clause 4, you say:
PN227
I'm directly but not solely responsible for their care and safety.
PN228
Who else would be involved in that care?---In that care, the unit as a whole is also responsible for - a generalised oversee of anything that might be out of the ordinary on the unit.
PN229
The RPN on duty would be responsible, wouldn’t he or she? The shift leader or shift manager would have that responsibility?---Not entirely. The shift leader has many other duties to do and they're quite - they do expect for us to report back to them if anything is happening out of the ordinary.
PN230
You gave evidence pertaining to clause 6 about the risk level assessment and the mental state examination. I'd like to ask you about those. Firstly, the risk level assessment, your evidence was that you are with a registered nurse or a medical officer, is that correct, when that risk level assessment is done?---With either the medical officer or the shift leader and not with any other medical - registered nurse on the ward.
PN231
Who has ultimate responsibility for that risk assessment?---I do.
PN232
Even though there's a more senior person with you, a medical officer or an
RPN - - -?---It is my duty to make sure that that's completed.
PN233
How long have you been doing risk assessments?---I would say about - roughly, I would say five, six years, suicide risk assessments.
PN234
How long have you been doing mental state examination assessments?---At least - well, from 2003 after doing the mental health course but before that time.
**** JENNY LYNN WATTS XXN MR CORBOY
PN235
Prior to that you were not involved in any mental state examinations?---Prior to that I was involved in mental state examinations and they're something that's not necessarily done on paper, they're a verbal checklist.
PN236
If I may characterise, you've been doing mental state examinations for a consideration period of time. Is that a fair summation?---Yes.
PN237
In undertaking a mental state examination or a risk - we'll do the mental state examination first, is that within the position description at Barwon Health?---Not that I remember for division 2 nurses.
PN238
Right, so you're going beyond your position description by doing a mental state examination?---I believe so.
PN239
And you've been doing that for a considerable period of time?---Mm.
PN240
Are you aware that evidence will be given that you are actually operating within your position description by undertaking that?---I'm sorry?
PN241
Are you aware that evidence will be given to this Commission that the mental state examination is part and parcel of the job description
in the role of an PSEN?
---Could you repeat that.
PN242
Are you aware that evidence will be given to the Commission that the mental state examination is part of your job description and part and parcel of PSEN2 role?---I don't recall that being in the current PSEN2 job description.
PN243
When you're undertaking these mental state examinations, are you operating within your scope of practice as a PSEN as outlined by the Nurses Board?---Yes, I do believe so.
PN244
May I take you to clause 10 of your statement. You say:
PN245
Participate regularly in professional development and staff in service education programs.
PN246
These are available to all psychiatric staff, are they not?---Yes, they are.
PN247
Is there an expectation that if you're available you will attend these education sessions?---Yes.
**** JENNY LYNN WATTS XXN MR CORBOY
PN248
Within your registration as a div 2 nurse, would you agree there's an expectation by the nurses Board that you would have continuing education?---Yes.
PN249
Clause 11:
PN250
Maintain annual competency, fire training, CPR training and .....
PN251
These three would be really the requirements of all staff in a psychiatric unit, would they not?---Yes.
PN252
Whether they're registered nurses or not?---Yes.
PN253
I take you to the nursing students. Are you aware that evidence will be given to the Commission that you're not solely responsible for these students while you're acting as a preceptor?---Yes.
PN254
Do you sign off on their training or is that someone else who signs off?---I actually sign off and then the shift leader countersigns my signature.
PN255
You gave evidence that you sign off on their nursing notes?---Yes, I do.
PN256
You would sign off because you actually are the registered nurse involved in the care of the patient, aren't you? It's your responsibility to sign off?---Yes.
PN257
In your evidence regarding students, if I'm correct in my notation, you said you educate them on all parts of mental illness. Do you recall saying that?---Yes.
PN258
Your education that you would deliver to them, would this be just your experience?---No,
PN259
How does it go beyond that?---I would educate them on different mental illnesses. I would also assist them and direct them to - and where to find, locate other literatures and further educating materials on those illnesses.
PN260
This education is within your experience as a PSEN, is it not, your experience with mental illness?---Is within my training.
PN261
It's within your scope of practice and your training and your experience, education that occurs, okay. Clause 14 you talk about a project that you undertook. Who led that project, can you recall?---Clause 14 was a conference.
**** JENNY LYNN WATTS XXN MR CORBOY
PN262
Yes, sorry, from ..... Barwon Health ..... speaking about enhanced scope of practice at conferences. This was a project, was it not, that led to this conference? Your enhanced scope of practice was a project that was undertaken at Barwon Health?---We were asked by a New Zealand team of nurses to go to New Zealand and speak about our duties and our scope of practice at Barwon Health.
PN263
That scope of practice that you did, evidence will be given that that was encouraged by the director of nursing, Lucy Cuddihy. Were
you aware of that?
---Are you talking clause 17, the division 2 - - -
PN264
No, I'm talking about the conference. My understanding is that the extended scope of practice project in the conference where you addressed, as a result of the extended scope of practice, resulted from Lucy Cuddihy's leadership in that project. Is that a correct statement?---I am aware that Lucy was supportive of the us speaking at New Zealand. I'm not sure if Lucy was aware of us speaking at the collaborative psychiatric nursing conference.
PN265
Is that a regular and ongoing feature, that you address conferences?---We were asked - it's not a regular feature. We have spoken at probably, I think about five conferences all up by invitation.
PN266
Over how many years?---Over about two years.
PN267
On five occasions you've spoken at conferences?---I think so, yes.
PN268
Clause 16 you say that you work in accordance with the Barwon Health position description?---Yes.
PN269
Evidence you've given to the Commission contradicts that. You said earlier that you've actually worked beyond your job description?---I believe that I do now.
PN270
Which is the correct evidence?---That I work beyond my job description.
PN271
Evidence will be given to this Commission that you are working within your job description. Are you aware that that evidence will be .....?---Yes.
PN272
I now go to clause 18, the medication administration, are you recognised by this medication administration in any other way?---I'm not sure what you mean.
**** JENNY LYNN WATTS XXN MR CORBOY
PN273
Do you receive an allowance or a qualification allowance for it?---No, I don't.
PN274
You administer medications without receiving the allowance?---That's correct.
PN275
Have you claimed the allowance?---No, I have not.
PN276
Are you aware that the allowance exists within the EBA?---No, not for medication administration, no.
PN277
You said that you attend a handover. Would all nursing staff attend a handover?
---Yes, they would.
PN278
You say that you check the patients and undertake progress notes. Would all nursing staff involved in patient care do that process?---Yes, they would.
PN279
I'd like to hand up to you an extract from the award. It is actually contained within Ms Guppy's statement and I'll hand a copy to
Ms Svendsen. What I'm handing up to you is an extract from our website which we have responsibilities under the industrial instruments
in appearing before this award and the first page is section 63, psychiatric enrolled nurse work level standards. Is that before
you?
---Yes.
PN280
Would you advise the Commission whether you work to this standard? Would you do the duties contained in this standard? There's only two pages of the standard there ..... clause M, subclause (M).
PN281
THE DEPUTY PRESIDENT: I thought we were talking about PSEN2s.
PN282
MR CORBOY: Yes, but a PSN2 does work with PSEN - - -
PN283
THE DEPUTY PRESIDENT: Additional work.
PN284
MR CORBOY: - - - and additional work as well. This is the routine or basic component.
PN285
THE DEPUTY PRESIDENT: There's a quick answer then, isn't there?
PN286
MR CORBOY: I would have thought so?---Yes, I believe I would do that.
**** JENNY LYNN WATTS XXN MR CORBOY
PN287
Very quickly, if I may take you through, subclause 63.3(a) establish a rapport with clients. You'd actually do that?---Yes.
PN288
Including the understanding of basic common illnesses, clause (b) you make routine observations?---Yes.
PN289
Clause (c) you undertake general observations?---Yes.
PN290
You teach clients in clause (e) about independent self-care?---Yes.
PN291
You assist in admission procedures in clause (g)?---Assist who?
PN292
Assist the clients?---Yes.
PN293
In admitting procedures:
PN294
Admission procedures when a new client enters the award.
PN295
?---Yes.
PN296
In clause (h) you'd welcome clients, in clause (i) you'd maintain a safe therapeutic environment, removing hazards, et cetera?---Yes.
PN297
Under direction carry out basic and therapeutic tasks and in clause (l) act immediately in nursing situations?---Yes.
PN298
Turn over a couple of pages, please. You've got a PSEN2 definition, clause 64. are you aware of this definition that's contained from the EBA?---Yes.
PN299
Would you undertake the tasks there?---Yes, but it's under the supervision of the shift leader and not just another RPN on the unit.
PN300
You would be responsible to a division 1 or a division 3 nurse, would you not, in your work?---I report back to the shift leader.
PN301
Who is an RPN1 or RPN3?---An RPN3.
PN302
In those duties do you see that they talk about independence to practice?---Yes.
**** JENNY LYNN WATTS XXN MR CORBOY
PN303
In those duties in clause (b) do they talk about complex initial entries of the clients, case histories?---Yes.
PN304
You undertake that level of complex work?---Yes.
PN305
Clause (c) in the eg. at the end with the therapeutic interventions, they talk about assisting the clients with daily living skills and health education?---Yes.
PN306
Is this to do with medications and their illness?---This would be to do with the medications, their illness, their lifestyle choices, drug and alcohol issues.
PN307
It's a very general, very broad factor?---Yes.
PN308
Clause (d), you're expected to lead sessions independently?---Yes.
PN309
Clause (e) you may work independently under the direction of an RPN - even though they talk about community settings, this what you actually do in the workplace, isn't it, that you work fairly independently?---Independently on the unit.
PN310
64(2) has got typical duties. Do you agree that those are the duties that you would undertake?---In clause (a) independent patient care strategies and to enable the RPN to develop nursing care plans, I develop the nursing strategies. I assess the problems and can develop the - when a person is admitted, an admission management plan is devised by myself.
PN311
Is that within your job description to do that?---I believe it is.
PN312
You're working within your job description when you do that?---Yes.
PN313
You've given evidence that you believe you work beyond the PSEN2 definition?
---Yes.
PN314
Would you like to indicate where that would be?---In my role as a primary nurse and as I've said before I undertake mental state examinations
and daily risk assessments. Once a risk assessment is completed, then a client is given a level of observation category according
to that assessment, being a 1 or a 2 or a 3 and sometimes a 4, 1 being that they are on hourly obs, they're considered at low risk;
2 is a slightly higher risk and they're on half hourly visual obs and 3 is a
15 minutes obs or they might be placed up to a very high risk. In that case they are specialled and that's a category 4 obs. It
is my job to maintain - to ensure that those observations are done at the time, particularly if they are on a category 3 obs. I
can't ask anybody else to do that, I'm the person that has to ensure that my clients are sighted and safe within that time and if
something is to go wrong, then I am the person accountable for that.
**** JENNY LYNN WATTS XXN MR CORBOY
PN315
Isn't that your role as a registered nurse in being accountable for those people, as a PSEN2? Isn't that your job to make sure they're safe, to make sure that they're observed, that they're monitored?---Yes, that's my job.
PN316
You actually talk about assessment, that mental health assessment is different to, are you aware in the job description under client care at Barwon Health the first dot point is:
PN317
Participate in the assessment, review and discharge of the allocated clients as required.
PN318
Are you aware of that?---Sorry?
PN319
Are you aware that in the Barwon Health job description it says to participate in the assessment, review and discharge of the allocated clients as required?---Yes.
PN320
By assessing clients, you're working within the job description?---Yes.
PN321
THE DEPUTY PRESIDENT: Sorry, you're reading from where, just for the transcript, Mr Corboy? Attachment what?
PN322
MR CORBOY: It was the attachment attached to Denise Guppy - I have it notated as DG3.
PN323
THE DEPUTY PRESIDENT: Thanks, no, that's lovely.
PN324
MR CORBOY: On what's been provided by the union.
PN325
THE DEPUTY PRESIDENT: Thank you. I just wanted to record that on transcript so that I can find the documents later.
PN326
MS SVENDSEN: I can - - -
PN327
THE DEPUTY PRESIDENT: No, I do have it.
PN328
MS SVENDSEN: - - - provide you with another copy.
PN329
THE DEPUTY PRESIDENT: I'm sure it's attached, thanks very much.
**** JENNY LYNN WATTS XXN MR CORBOY
PN330
MS SVENDSEN: It is there.
PN331
THE DEPUTY PRESIDENT: No, no, thank you very much, Ms Svendsen. I just want it recorded on transcript so I can find it later easily.
PN332
MR CORBOY: Are you aware of the seniors' allowance clause contained within the award?---Yes, I am.
PN333
Sorry, the EBA, I should say?---Yes, I am.
PN334
Your Honour, if I say award, I do mean EBA. I'll try and get it correct. I'd like to hand up an extract from our website and that has been provided by the union as part of their submission.
PN335
THE DEPUTY PRESIDENT: This is the agreement, is it?
PN336
MR CORBOY: It is an extract from the agreement, clause 21.15 which your Honour has referred to. Your Honour, I'd like to keep this document and the PSEN information I handed up to be used for the witnesses that are here today.
PN337
Can you please turn to the second page, to clause 21.15. Can I take you to subclause (c). Do you have that before you?---Yes.
PN338
They're talking about the net additional value there and in each one of those subclauses there is the word "and" is there not?---Yes.
PN339
What would be your understanding of the purpose of that "and"? Would you have to do all the duties or just one?
PN340
THE DEPUTY PRESIDENT: If I may be so bold, I'm not sure we need an interpretation of a clause from a registered nurse. That's a matter for the submissions, if that's all right.
PN341
MR CORBOY: Certainly, yes.
PN342
MS SVENDSEN: If I may be so bold myself, it is actually agreed that it is a matter - - -
PN343
THE DEPUTY PRESIDENT: That's fine. Thank you for that. Go ahead. Sorry to interrupt you, sir.
**** JENNY LYNN WATTS XXN MR CORBOY
PN344
MR CORBOY: Your contention is that you would undertake all those requirements of that clause in claiming the seniors' allowance today?---Yes.
PN345
Earlier you gave evidence that other PSENs do your role save for the administration of medication. Do you recall that evidence?---I'm sorry?
PN346
Earlier you gave evidence to the Commission that other PSEN2s do your role save for the administration of medication. You said that was the difference between your function and other PSEN2s?---Yes.
PN347
By that you would concede that PSEN2s on the ward operate at the same level as you do save for that component?---Apart from the medications, there are some, yes.
PN348
Thank you, your Honour.
PN349
THE DEPUTY PRESIDENT: Any re-examination?
MS SVENDSEN: There is, your Honour.
<RE-EXAMINATION BY MS SVENDSEN [11.47AM]
PN351
MS SVENDSEN: Jenny, could you please talk to us about the difference between your experience as a PSEN2 and your psychiatric endorsement, the mental health course?---My personal experience as a PSEN2, I've been a PSEN2 for the last 18 years. Prior to that I was a PSEN1 or back then we were called mental health aides. About 18 years ago, I'm not exactly sure of the year, but there was a push by the union to upgrade all PSENs that worked on an acute unit to be upgraded to a level 2. That was 18 years ago and since that time there's been no further gradings. I've been on the acute unit at the Swanston centre for actually 20 years and in the last - in 2003 I did the mental health course which formally recognised and formally gave me further mental health training.
PN352
Your mental health training is what you receive a qualifications allowance for. Is that right?---That is correct, yes.
PN353
You subsequently got your medication endorsement?---Two years after that time, yes, I did.
PN354
Is there any provision that you're aware of that allows you to have an additional qualification allowance?---No.
**** JENNY LYNN WATTS RXN MS SVENDSEN
PN355
THE DEPUTY PRESIDENT: There's no medication allowance?
PN356
MS SVENDSEN: There is no medication allowance.
PN357
Can you tell me whether the other PSEN2s on the unit are psych endorsed?
---There is one PSEN2 who has not done his mental health training and he is currently getting - he's currently being paid at the
same level as the rest of us on the unit. He's being paid as a PSEN2.
PN358
Is his work the same as yours?---Yes, it is.
PN359
In all aspects?---Apart from medications.
PN360
You were asked about the position description from Barwon Health Do you have a copy of it in front of you?---No, I don't, not in front of me.
PN361
Your Honour, this is DG3 that we referred to earlier.
PN362
THE DEPUTY PRESIDENT: Denise Guppy 3, thanks.
PN363
MS SVENDSEN: I'll also provide you with a copy.
PN364
THE DEPUTY PRESIDENT: I should be able to find it on this occasion.
PN365
MS SVENDSEN: Two major questions, can you find where in this job description it says that you should be doing mental state examinations or risk assessments?---No, I can't.
PN366
THE DEPUTY PRESIDENT: Would it be routine observations of clients, including clinical observations, administered treatments, et cetera, third dot point under client care? Does that apply or not? Does that constitute?
PN367
MS SVENDSEN: Does that constitute a risk assessment or a mental state examination?---I don't think so.
PN368
THE DEPUTY PRESIDENT: Why not? Sorry for interrupting. Why not, in your view?---A risk assessment, I actually sit down - before doing a risk assessment, I sit down with a client and ask them certain questions as to how they're actually feeling on the unit, how they're - and I need to also gather a bit of a history from them as well. Routine observations, I interpret this as a set of physical observations.
**** JENNY LYNN WATTS RXN MS SVENDSEN
PN369
Physical observations?---Yes.
PN370
MS SVENDSEN: Could you look at the definition that was handed to you by Mr Corboy, PSEN2 and PSEN1 classification standards from the agreement. Can you find anywhere in here where it talks about things such as mental state examination or risk assessments or preceptorship?---No.
PN371
THE DEPUTY PRESIDENT: It wouldn't be 64.2.A, more complex - no, it's initial interviews, isn't it. Sorry, ignore the question, it's initial interviews.
PN372
MS SVENDSEN: We have no further questions, thank you, your Honour.
PN373
THE DEPUTY PRESIDENT: Anything else from anybody?
MR CORBOY: I'm sorry, your Honour, just a point of clarity. There was new evidence that came through.
<FURTHER CROSS-EXAMINATION BY MR CORBOY [11.56AM]
PN375
MR CORBOY: Ms Watts, you said that there was another PSEN who was undertaking training. You didn't name that person but you said
there was one?
---No, they're not undertaking training.
PN376
I thought they were doing the psychiatric nursing - - -?---No. They are working on the unit and they are getting paid at the same rate that - - -
PN377
They don't have your additional qualification in psychiatric nursing. Is that what you're saying?---That's correct.
PN378
You said they were being paid the same?---Yes.
PN379
That's not true, is it, because you receive an allowance for your psychiatric course?---At the same pay rate, excluding allowances.
PN380
That course is actually covered by an allowance, isn't it?---The mental health course.
PN381
Is that correct?---Yes.
PN382
You actually receive different pays, one recognises the course, one doesn't and when he finishes the course he'll be eligible for
that allowance, I would assume?
---He's not doing a course.
**** JENNY LYNN WATTS FXXN MR CORBOY
PN383
Sorry, apologies, I misheard. You actually receive different rates of pay recognising different qualifications?---We are operating at the same pay point - scale and yes, I get a 4 per cent certificate allowance for my mental health course.
PN384
Pay point is a progression within the EBA which allows for experience and training to be recognised. Is that correct?---Yes.
PN385
He would have a similar level experience and training save for that qualification?
---He has not done the medication course as well.
PN386
Thank you, your Honour.
THE DEPUTY PRESIDENT: Thank you very much for giving your evidence, you're excused?---Thank you.
<THE WITNESS WITHDREW [11.58AM]
PN388
THE DEPUTY PRESIDENT: I'll take a five minute adjournment if that's all right with the parties.
<SHORT ADJOURNMENT [11.58AM]
<RESUMED [12.05PM]
THE DEPUTY PRESIDENT: Ms Svendsen.
<SANDRA GAYLE WATTS, AFFIRMED [12.06PM]
<EXAMINATION-IN-CHIEF BY MS SVENDSEN
PN390
MS SVENDSEN: Thank you, Sandy, if you could please direct your answers to his Honour and make sure you speak into the microphone so the recorder can get you. Do you have in front of you a copy of your witness statement?---Yes, I do.
PN391
Is that a true and correct statement?---It is.
I'll tender that in evidence, your Honour.
EXHIBIT #HSU3 WITNESS STATEMENT OF SANDRA GAYLE WATTS
PN393
THE DEPUTY PRESIDENT: Go ahead.
PN394
MS SVENDSEN: I'll provide you with the marked exhibits in case they're referred to.
PN395
Sandy, could you tell us what you believe that you undertake during your work each day that is in excess of the PSEN2 classification standards?---I've worked as a division 2 nurse in psychiatry for 26 and a half years and my role in that period has changed hugely. I now have far more responsibility in my role, working as a primary nurse on the acute unit. I'm required to have a very high level of judgment, decision-making skills, accountability and responsibility and work quite independently and yes, I mean, the decisions that I have to make on a daily basis, including patient risk assessments, mental state examinations, liaising directly with medical staff and they consult me about my opinions on the patients' conditions and in part of their treatment planning, regular observations of client's safety and their progress and I directly liaise with many community agencies and other parts of the Barwon Health service, community teams and I do admission management plans when a patient is admitted and am directly involved in discharge planning. I now dispense the patients' medications that are in my care. That can be up to five patients on any shift. I have increased my level of education over those years a lot which has affected my job a lot in recent years, allowing me to work to this level, including two mental health courses and two medication courses. I've almost completed a preceptorship course which I work with student nurses in division 1 and 2 and have them working directly with me for many shifts and educate the students about psych nursing and patients' conditions and the treatment available and give them a basic understanding of psychiatry within that three or four weeks that they may be on the ward. I think over those years my level of responsibility in the job has greatly increased.
**** SANDRA GAYLE WATTS XN MS SVENDSEN
PN396
You said that your level of education had affected your job significantly in recent years. Could you expand upon that specifically?---Yes. Well, I've completed the - in fact two six month mental health courses over the years, more recently in the last few years I've done a second mental health course and particularly the medication courses that I've completed, that has increased the responsibility level significantly. Now, when I say I'm working independently on the ward, dispensing patients' medications, I mean, yes, you've got to be very alert to the potential risks involved there and I think, you know, going from not doing that to - I mean, it is within the scope of practice, of course, but yes, just an overall responsibility in being directly responsible for my decision-making with the medications and mental state assessments and monitoring and liaising with - I mean, you're involved in family meetings and medical reviews of patients on a regular basis and directly have input into that. Had I not done, you know, the mental health courses and medication courses, I wouldn't have been involved to this level, and the preceptorship, of course, as well, yes, being able to educate the students that come through our service on a regular basis.
PN397
How long have you been a PSEN2?--- I have been a PSEN2 in the mental health service since - well, initially - I've been in psych for 26 and a half years and I think it was a few years after that that I became a PSEN2 on the acute ward at Dacks House.
PN398
Which was the precursor to the Swanston unit?---Yes, that's right. I think it's about 18 years that I've been a PSEN2, sorry.
PN399
My apologies, I just need to come back to what question I was about to ask. You indicated that your role and responsibilities have changed dramatically over your time. Has that changed since you became a PSEN2?---Yes, yes, I think it has really. In the early stages as a division 2 nurse in the early years we were just task orientated, sort of nurses just helping out wherever required, like doing observations, just, you know, stocking cupboards and all sorts of things like that but now we're really one of the primary nurses who pretty much does practically the same as everybody else on the ward and directly responsible for our patient load with very little input from the person in charge of the shift.
PN400
No further questions at the moment, your Honour, thank you.
**** SANDRA GAYLE WATTS XN MS SVENDSEN
PN401
THE DEPUTY PRESIDENT: Any cross-examination?
<CROSS-EXAMINATION BY MR CORBOY [12.14PM]
PN402
MR CORBOY: Ms Watts, may I take you to your witness statement which is HSU3. Do you have that before you?---Yes.
PN403
I take you to clause 3, the course in medication administration. This is within the scope of practice outlined by the Nurses Board, isn't it?---Yes, it is.
PN404
A PSEN or SEN would undertake this course and once endorsed they could administer medication within the guidelines. Is that correct?---Yes.
PN405
Clause 4, you indicate that you perform a high level of judgment responsibility. In undertaking this. Do you believe that you are
within your scope of practice?
---Yes, I always work within my scope of practice.
PN406
Do you believe you work within the position description at Barwon Health?
---Within the position description?
PN407
Position description at Barwon Health?---Yes, but I think the position description is due for review really, to - I mean, I think the position description as a PSEN2 on the ward is very similar to that of the RPN2 in comparison, with very little difference.
PN408
But they are different, aren't they?---There is slight differences.
PN409
You're answerable to an RPN1 or an RPN3 on the ward?---The shift leader, yes.
PN410
You're responsible to that shift leader for the work you undertake?---They're the overall person in charge.
PN411
The shift leader has got other things in their job description, for example, seclusion. The shift leader is the one who can authorise
seclusion. Is that correct?
---That's right.
PN412
Can you authorise seclusion?---No.
PN413
Just going over the page if I may, clause 7?---Yes.
**** SANDRA GAYLE WATTS XXN MR CORBOY
PN414
About the fifth or sixth line down:
PN415
I try and give them a basic understanding of the role of a psychiatric nurse.
PN416
That sentence there, is that within your experience and your scope as a PSEN2, that you provide that education?---Well, within my experience, well, yes, but that's extensive experience and it's really no different to any other primary nurse on the ward really.
PN417
You characterise as a basic understanding, the role of a psychiatric nurse. That's how you characterise it?---I attempt to give the students a basic understanding within the limited time they're on the ward. They only have three to four weeks on the ward and so that's really only enough time to allow them to get a basic understanding of psychiatry and how it works.
PN418
Clause 8, your role in high level observation. Do you believe that this high level assessment is actually beyond what's included in the PSEN2 role, function and duties?---I believe that the role we have at Barwon Health as a PSEN2 on the acute unit is more than likely a higher level of decision-making and functioning than that of other services.
PN419
Have you worked at other services?---No, I haven't but I have heard of - - -
PN420
You have no direct knowledge of other services?--- - - - feedback. I haven't experienced other services but I just - what I've heard from various sources, yes.
PN421
You've heard but you haven't actually worked in those services?---No, I haven't.
PN422
I'd like to take you to clause 15. You say in there advanced clinical skills. Evidence will be given to this Commission that your advanced skills are within the role and expectation of PSEN2. What do you say to that?---Within the role of a PSEN2?
PN423
Yes?---Well, yes, it's within the role of a PSEN2 but it's probably in fact beyond the basic PSEN2 role.
PN424
It is within the role. You gave evidence that it is within the role?---The things that are covered in the job description, yes, we work to that.
**** SANDRA GAYLE WATTS XXN MR CORBOY
PN425
Clause 16 regarding conferences. I've counted up that there are four occasions that you've either attended or provided information at a conference. Is this a regular and ongoing requirement or is it just those four occasions that you've done this?---There's nothing planned for the future at this stage.
PN426
I'd like to hand up to you two documents and, your Honour, I was wondering for convenience should we label these.
PN427
THE DEPUTY PRESIDENT: Yes. What are they? Are they new documents or are they already there?
PN428
MR CORBOY: No, they're the ones used by the previous witness, your Honour.
PN429
THE DEPUTY PRESIDENT: For the record there's the - one document is
clause 21, the allowances of the certified agreement, the other document is clause 63 of the - - -
PN430
MR CORBOY: I believe 64 as well, your Honour
PN431
THE DEPUTY PRESIDENT: 63 and 64 of the agreement again?
PN432
MR CORBOY: Yes. Are you going to notate them, your Honour?
PN433
THE DEPUTY PRESIDENT: No, I don't notate the agreement. The agreement is a legal document which we're all governed by.
PN434
MR CORBOY: I'll take you to the first one, clause 63, psychiatric enrolled nurse work level standards, You gave evidence that you were a PSEN and then became a PSEN2?---Yes.
PN435
This is from the EBA and it lists the typical duties of a PSEN1.
PN436
THE DEPUTY PRESIDENT: Ask the question, Mr Corboy.
PN437
MR CORBOY: Do you undertake all the duties?---Well, I haven't had a chance to read it all yet.
PN438
THE DEPUTY PRESIDENT: That was my fault.
**** SANDRA GAYLE WATTS XXN MR CORBOY
PN439
MR CORBOY: That's fine, your Honour.
PN440
Would you like to quickly look at it?---Yes, I do believe I cover all of those things.
PN441
Clause 64 has got the PSEN2 definitions. Are you familiar with these?---So this would be pretty much the same as the - - -
PN442
It's the same as the EBA. It's an extract from the EBA?---Yes.
PN443
You'll see in there they talk about operating at an independent level?---Yes.
PN444
There's also an expectation indeed that you record client progress, attend meetings, make substantial contribution?---Sorry, what point would this be?
PN445
Subclause (d)?---Yes, that's right.
PN446
Subclause (e) they talk about working independently of the RPN. You've given evidence here that you do work independently of the
RPN in your daily activities?
---I'll just have a read of this point.
PN447
Sure, and 64 too, if you could cast your attention to that?---Yes, that seems to be okay.
PN448
Do you undertake those duties?---Yes.
PN449
The mental state examination you referred to, how many years have you been doing that?---Gosh, probably 15. That would be an estimate. I would have to think about that a bit longer.
PN450
That's fair enough. You weren't to know I was going to ask that question today.
The second question, the risk assessment that you indicated, approximately how many years have you been undertaking that?---Well,
in the early stages risk assessments didn't exist back in the early years. Once again I would be estimating that possibly risk assessments
may have been around for possibly 10 years. That would be a very rough estimate.
PN451
I thank you for that?---As long as they've been introduced to the ward I've been doing them.
**** SANDRA GAYLE WATTS XXN MR CORBOY
PN452
The risk assessment and mental state examinations, is that within the policy and practice guidelines of the unit?---Of the unit, yes.
PN453
Do other PSEN2s, as far as you're aware undertake those assessments?---They do.
PN454
I'd like to refer you to the job description, DG3, which I believe is available to the Commission. I only had one copy. It was handed up. Is this a document which you've seen before at Barwon Health?---Yes, it is.
PN455
Can you turn over to page 2, please, under client care. The assessment review and discharge of the allocated patients, would this go to what you were talking about - the evidence you gave earlier about you were involved in discharge planning and assessing patients?
PN456
THE DEPUTY PRESIDENT: Sorry, where is this, under client care?
PN457
MR CORBOY: The fist dot point, your Honour, client care.
PN458
Is this what you captured in your evidence, that process?---Yes.
PN459
Would a mental health assessment be under this?---Yes, an assessment would be done.
PN460
A risk assessment would be under this as well?---As far as - - -
PN461
Would a risk assessment be covered by this?---Yes.
PN462
You've already given evidence that you're operating within your job description. Do you believe you exceed your job description in any way?---Exceed the job description, not - well, I think we cover everything - - -
PN463
THE DEPUTY PRESIDENT: Sorry, I missed that?---I think we cover everything on the job description which is, as I said before, very comparable with that of the RPN2s on the ward.
PN464
MR CORBOY: My next question is, the PSEN2 role, do you believe you work within that scope as well or do you exceed that?---I work within the role as a PSEN2.
**** SANDRA GAYLE WATTS XXN MR CORBOY
PN465
No further questions, your Honour.
THE DEPUTY PRESIDENT: Any re-examination?
<RE-EXAMINATION BY MS SVENDSEN [12.28PM]
PN467
MS SVENDSEN: You gave evidence that you were answerable to the shift leader in relation to your work. Are you answerable to the other div 1, div 3s on the unit?---No.
PN468
Who are the div 1s and the div 3s on the unit answerable to?---The unit manager - sorry, can I ask - - -
PN469
Who are the div 1s and div 3s working on the unit answerable to?---Sorry, yes, I thought you meant the shift leader. They're answerable to the shift leader as are we.
PN470
It's the same process?---The same, exactly the same.
PN471
They report back to the shift leader. Is that what you're saying?---Yes. As a primary nurse we all just report to the shift leader.
PN472
There's no difference?---No.
PN473
Can the other RPN2s on the unit authorise seclusion?---The shift leader
authorises - - -
PN474
Sorry?---The shift leader authorises seclusion..
PN475
The other RPNs don't authorise seclusion?---No.
PN476
No further questions.
MR CORBOY: Sorry, your Honour, I'm trying your patience this afternoon.
<FURTHER CROSS-EXAMINATION BY MR CORBOY [12.29PM]
PN478
MR CORBOY: In the absence of the shift leader, who would authorise seclusion? Would an RPN1 or RPN3 on duty do that?---Well, the shift leader is pretty much always available.
**** SANDRA GAYLE WATTS FXXN MR CORBOY
PN479
If the shift leader is away from the unit for any reason, who would authorise seclusion?---I can't ever remember a circumstance like that happening, to be honest.
PN480
You've already given evidence you cannot authorise seclusion?---Yes.
PN481
Are you aware that a division 1 or division 3 in the absence of the shift leader can authorise seclusion?---I'm not sure about that fact because it's never been a circumstance that's happened because the shift leader is always pretty much available.
PN482
Thank you.
PN483
THE DEPUTY PRESIDENT: Anything arising from that, Ms Svendsen?
PN484
MS SVENDSEN: No, thank you, your Honour.
THE DEPUTY PRESIDENT: Thank you very much for giving evidence, you're excused?---Thank you.
<THE WITNESS WITHDREW [12.30PM]
PN486
THE DEPUTY PRESIDENT: Next witness, Rosemary, is it?
PN487
MS SVENDSEN: Rosemary Kallasmae.
PN488
THE DEPUTY PRESIDENT: I must admit I'm a bit concerned by some of the questions. I mean, if people perform duties outside the scope of a PSEN2, they may be struck off so I'm not sure that's the test, is it? It's a legal argument but I just raise it while the witness isn't here.
PN489
MR CORBOY: I'll be dealing with that in my submissions because it does go to 21 of the - - -
THE DEPUTY PRESIDENT: No, that's excellent. I just raise it.
<ROSEMARY JOY KALLASMAE, AFFIRMED [12.32PM]
<EXAMINATION-IN-CHIEF BY MS SVENDSEN
PN491
MS SVENDSEN: Rosemary, if you would like to direct your answers to Deputy President Hamilton and make sure that you speak into the microphone so the recorder can get you. Do you have a copy of your witness statement in front of you?---Yes, I do.
PN492
Is that true and correct?---Yes, it is.
THE DEPUTY PRESIDENT: Tender it?
EXHIBIT #HSU4 WITNESS STATEMENT OF ROSEMARY JOY KALLASMAE
MS SVENDSEN: In the interests of time, your Honour, I think we've actually covered the issues that we could cover with Rosemary and I'll ask no further questions at this time.
<CROSS-EXAMINATION BY MR CORBOY [12.33PM]
PN495
MR CORBOY: If I may ask those two documents to be provided to the witness.
PN496
THE DEPUTY PRESIDENT: The agreement clauses and the Barwon Health position description, yes.
PN497
MR CORBOY: Just if I may ask a general question about your statement,
Ms Kallasmae. Is that how you pronounce it?---Kallasmae.
PN498
Your witness statement goes to a range of duties that you claim to undertake and especially at clause 6 where you talk about the primary nurse duties. These duties listed there, would they be covered by the position description at Barwon Health? Do you work within your position description, might be an easier way of answering that?---I don't think it fully - I think we do more than what that description states.
PN499
All right do you work within, I’ve provided to you clause 63 and clause 64 being the state enrolled nurse work level standards for a PSE1 and three pages on you have the PSEN2 definition. I’d like to take you to the first document there and I want you to read through that just the two pages and advise me whether you undertake - - -
PN500
THE DEPUTY PRESIDENT: Is that a matter of agreement that each of the three employees meets the classification description in the agreement, it is isn’t it?
**** ROSEMARY JOY KALLASMAE XXN MR CORBOY
PN501
MR CORBOY: I would have assumed so your Honour.
PN502
MS SVENDSEN: There is as far as we’re concerned.
PN503
THE DEPUTY PRESIDENT: Can we move to the position description which may be a – I’m just asking if we can’t we can’t but if it’s agreed I don’t see the point of it.
PN504
MR CORBOY: Well it’s important that each witness understands that they work within that particular - - -
PN505
THE DEPUTY PRESIDENT: All right, if it’s relevant go ahead Mr Corboy.
PN506
MR CORBOY: Yes?---Did you want me to read?
PN507
Yes, clause 63 the PSEN1 definition it goes on second page, and finishes at clause (m) that’s straight from the EBA so its the expected duties for the PSEN1?---If you are asked to work at the Swanston centre.
PN508
Yes?---We need to be a level 2 PSEN.
PN509
Yes but in that level 2 duties would you undertake level 1 duties as well?---I’m sure we probably do.
PN510
Yes, okay thank you. If you like to turn to clause 64 which is two pages over, it is and you’ve got the PSEN2 features. Are you familiar with this clause out of the EBA? My question will be do you work within that clause?---Yes, I’m sure we do.
PN511
Thank you does the witness have the position description for DG3? The position description, I’d like you to turn to page 2 please client care. Having regard for your statement do you believe that you – I’ll ask this question again. Do you exceed the job description in the role that you perform?---I’m not sure what you mean by that.
PN512
Okay you said earlier that you exceeds the job description, do more than what is in the job description?---Well yes because we do primary nursing that’s not listed in any of this documentation.
**** ROSEMARY JOY KALLASMAE XXN MR CORBOY
PN513
So you believe that primary nursing is not covered by the position description. Evidence will be given to this Commission that it is what do you say to that? That you disagree?---Yes.
PN514
May I go back to your statement and we just explore clause 6. Is there any item in that clause or subclause that you would contend
exceeds the expectation of a PSEN2, either within that document I handed up or the position description?
---Everything that I’ve written here is things that I actually do.
PN515
Do you believe that exceeds, in other words it is greater than, the expectation of PSEN2?---Yes.
PN516
You do?---I do.
PN517
So if I take you to the first clause mental state observations of patients, do you believe that’s in excess of the PSEN2 role?---It is something that we do every day that we’re actually.
PN518
Yes, but is that greater than the expectation in the PSEN2 document?---See most of what I believe that is in this document is talking about task nursing.
PN519
Okay I’m referring you back to the PSEN2 definition and I’m saying to you in clause 6 you’ve given evidence that it is greater than the role, I’m asking you to identify as we go through, is this greater than the role, SEN2 clause 6(a) is that something that the SEN2 would do?---I’m not really sure what you want me to answer.
PN520
Okay would a PSEN2 conduct physical and mental state observations on their patients and report changes to their team leader?---Of course we do.
PN521
Yes, okay, clause (b) would they be involved in the medical reviews of
patients?---Yes.
PN522
Would a PSEN2 develop and implement management plans for the patient?---I do that.
PN523
Would a PSEN2 do that, I’m talking about the role?---Yes.
PN524
Okay would a PSEN2 complete risk assessments and maintain visual observations?---Yes.
**** ROSEMARY JOY KALLASMAE XXN MR CORBOY
PN525
I’d like you to go down that list and advise me what in that list ending in L that is not covered by the PSEN2 role? I would put it to you that all those duties are covered by the PSEN2 role is that correct?---I’m not sure.
PN526
Is that your answer you’re not sure?---Well I’m sure that I do everything that is documented in this document.
PN527
Yes right okay well I may have to reduce that to a summary at some stage. Just if I may go to clause (6k) the risk man, that’s really a responsibility of any staff member that’s involved in an incident isn’t it?---Yes, but nobody supervises what you write you actually type what you see and what you - - -
PN528
But that’s the responsibility of any staff member isn’t it?---Not everybody has access to risk man, not every staff member. Nursing staff do, I can’t necessarily say a cafeteria staff member would have the same.
PN529
Evidence will be given that it’s a general requirement for staff to fill out risk man reports if they are involved in the incident, as per policy are you aware of that evidence?---No.
PN530
Just going down you talk about in clause 12 the perceptorship training?---Yes.
PN531
Have all staff on the – is this available to all staff on the unit?---Not all staff have done it.
PN532
Is it available was my question?---No, not always because the last – they’ve recently just done another perceptorship training and prior to that was one we did was the previous one before that.
PN533
But any nursing staff member can apply for that training?---When we did the preceptorship training we were invited to do it by the Education Department and not every nurse at the particular time was asked to do it. There were lots that wanted to do it but didn’t get the invitation.
PN534
Right so there are – if I may characterise it differently, if a nurse wants to do it she can apply to do that course, is that your understanding of how it works?---I know for a fact that there’s lots of nurses that would like to do it but they haven’t been able to do it.
**** ROSEMARY JOY KALLASMAE XXN MR CORBOY
PN535
Clause 13, the medication endorsement?---Yes.
PN536
Can you advise the Commission whether this was within the scope of practice of a PSEN?---Not in the documentation that you’ve presented here it’s not because our job description hasn’t been redone since 2002.
PN537
So whereabouts is that scope of practise contained from your knowledge?---From my knowledge, from the Australian Nursing Council.
PN538
Australian Nursing Council?---Yes.
PN539
An extension of that is the Nursing Board Victoria?---Yes, that’s right.
PN540
Clause 15 you talk about a conference where you attended?---Yes.
PN541
I’ve counted up that there are two occasions is that right where you’ve attended this conference?---Four.
PN542
Four occasions?---Yes, actually five if I count the first one.
PN543
Five?---Yes.
PN544
Okay well done is this a regular feature, or are they five episodes?---The very first one that I actually got approached to do was for Barwon Health, it was about the scope of division 2 nurses in Barwon Health and they actually asked us to actually attend and they kept asking us to actually speak at this conference. It’s not something that I would normally do, and from that conference the rest have evolved.
PN545
Have you performed it since 2007 in your statement?---No, I haven’t.
PN546
Okay so it’s not a regular ongoing requirement?---It’s not a requirement.
PN547
All right I think that’s all your Honour thank you.
**** ROSEMARY JOY KALLASMAE XXN MR CORBOY
PN548
THE COMMISSIONER: Any re-examination?
<RE-EXAMINATION BY MS SVENDSEN [12.46PM]
PN549
MS SVENDSEN: Rosemary could you talk very briefly about the subject of those conferences?---The subject was about our role as division 2 nurses and our scope of practice and how what we do as primary nurses because most division 2 nurses don’t work as primary nurses, but they simply work as task they’re actually told what to do and when to do it. It’s like a task, we’re told to go and do someone obviously because they are looking unwell. We basically do that routinely, it’s right.
PN550
You right?---Yes I think so.
PN551
It’s okay you’re right?---We also spoke about the fact that we’re mostly supported by our colleagues about what we do and all of everything that I’ve ever done has been paid for by Barwon Health all the courses that I’ve ever done and been encouraged to do by our educators. We’ve always been encouraged and we’ve always been supported. I mean I’m 53 years old now and for my scope of practice in the last three or four years, I’ve done more education now than I’ve ever done earlier in my career and you would think that at my age you would be winding down not expanding how you work. So basically as an SEN that works within the psychiatric sitting, I’ve grown as a person and as a nurse from what I’ve done. It’s really hard to describe the passion that I feel about my being a division 2 nurse because I feel that I haven’t finished my scope of practice and my learning scope of what I actually do. Sure I could go and become a division 1 nurse, but I still haven’t finished what I’m really about. I mean for me as a division 2 nurse working for Barwon Health I’ve always felt supported and encouraged to do everything until now really.
PN552
Thank you, Rosemary no further questions.
THE DEPUTY PRESIDENT: Mr Corboy.
<FURTHER CROSS-EXAMINATION BY MR CORBOY [12.49PM]
PN554
MR CORBOY: You gave evidence that most the SEN’s don’t work as primary nurses?---In our hospitals, I’m not talking about -- -
PN555
In other hospitals, have you worked in other hospitals?---I have in the past yes.
**** ROSEMARY JOY KALLASMAE FXXN MR CORBOY
PN556
In the past how long ago?---A long – like I’ve been in Barwon Health since 1988.
PN557
So you have no current or recent knowledge?---I just know that when talking with colleagues that work in other psychiatric hospitals they basically don’t do primary nursing model, we do it, but they don’t. They basically have they’re told what they need to do, what they need, yes.
PN558
This extension to your scope of practice which you’re very passionate about, I’ll just reiterate that’s within your scope of practice and role and function of PSEN2?---Yes.
PN559
Yes and you seem to talk about the div 2 role more or less expanding over the years?---It has in the last – in the last three years it’s expanded.
PN560
But this is I would put to you that this is a general movement by the Nurses Board to actually enrich the role of a div 2 nurse, is that a reasonable statement?---I would believe that the nursing council is actually quite progressive in what they want the division 2 nurses to be doing. I don’t believe that my job description really flows to that because if it did my job description would be 2008, not 2002 before we did the scope of practice of being endorsed and.
PN561
Okay thank you your Honour.
PN562
THE DEPUTY PRESIDENT: Anything arising from that Ms Svendsen?
PN563
MS SVENDSEN: No thank you your Honour.
THE DEPUTY PRESIDENT: Thank you very much for giving evidence you’re excused.
<THE WITNESS WITHDREW [12.51PM]
PN565
MS SVENDSEN: Your Honour if I might have a five minute adjournment please?
PN566
THE DEPUTY PRESIDENT: Well I was going to adjourn anyway. So why don’t we adjourn until 2 o’clock, would that be appropriate?
PN567
MR CORBOY: At the risk of pressing - - -
PN568
THE DEPUTY PRESIDENT: We’ll go off the record to discuss procedures.
<LUNCHEON ADJOURNMENT [12.51PM]
<RESUMED [1.33PM]
PN569
THE DEPUTY PRESIDENT: Right where were we, Ms Svendsen next witness.
MS SVENDSEN: We are calling Ms Pope.
<SID DONALD POPE, AFFIRMED [1.34PM]
<EXAMINATION-IN-CHIEF BY MS SVENDSEN
PN571
MS SVENDSEN: Mr Pope do you have a copy of your statement?---No, I don’t at the moment, thank you.
PN572
There is one matter that we need to clarify straight away, in the first sentence we’ve indicated that you are a registered nurse division with x years of service would you like to actually clarify that please?---Yes, that 17.
PN573
17 years of experience. Have you read your statement?---I have.
PN574
Is it true and correct?---It is.
We tender the statement in evidence.
EXHIBIT #HSU5 WITNESS STATEMENT OF SID POPE
PN576
MS SVENDSEN: I think in the interests of time I’m going to let Mr Corboy cross-examine thank you, your Honour.
THE DEPUTY PRESIDENT: All right thanks very much. Mr Corboy.
<CROSS-EXAMINATION BY MR CORBOY [1.35PM]
PN578
MR CORBOY: Mr Pope in your statement in clause 2 you said you were the acting program manager, how long were you in that role for?---Approximately 18 months.
PN579
18 months thank you and what’s your current role now?---I’m a triage nurse, a psychiatric triage nurse.
PN580
How long has it been since you’ve worked with the three applicants today?---I well I work with them currently. In my role as a tirage nurse I work with them, I operate within the ward as well as within the triage service.
PN581
So the triage process or service works in t he ward as well as in the - - -?---I admit patients into the ward, I give handovers to the staff.
PN582
That’s fine, because normally triage is an administration process?---That’s correct.
PN583
So in that process of admitting patients, that would be taking patient to the ward and then handover and then you resume your role?---That’s correct.
**** SID DONALD POPE XXN MR CORBOY
PN584
Okay so the day to day nursing that these nurses would undertake you would not observe that not directly at this point no.
PN585
Okay if I may go to point 5, to replace these nurses you’d have to employ experienced division 3 registered nurses, do you believe that statement to be correct?---Yes, I do.
PN586
What would happen if an PSEN with 10 years experience came along in acute, would they be able to satisfy the job description?---Provided they practise at the level these guys did, yes they would.
PN587
Okay so a division 2 or a PSEN could actually do that role?---Yes, I wouldn’t be able to argue that no.
PN588
Okay now you talk in clause 7 about the direct care model in this unit, now evidence has been given to the Commission that the direct care model is where the clients or patients are allocated you know so many per nurse who undertakes primary care, is that roughly what the direct care model is?---That’s what I understand it to be yes.
PN589
You also – and in that allocation the nurses would have four or five, because that’s the evidence that’s been given to the Commission?---Yes, certainly.
PN590
Certainly okay, thank you?---Depending on the number of clients on the ward at any given time it would be evenly allocated across the staff that were employed for that shift.
PN591
How long has it been since you were in that acting role?---Which acting role are you referring to?
PN592
Into the acting program manager?---It would be approximately two years I think.
PN593
Now in clause 10 of your statement same conclusion:
PN594
I believe without reservation that all three nurses practise beyond their job description however they extend the scope of practice on a daily basis.
PN595
That statement is true and correct?---Yes, it is.
**** SID DONALD POPE XXN MR CORBOY
PN596
So would they practise beyond the role of a PSEN2?---I believe so yes.
PN597
Okay could we please hand up the clause 63 and 64 as well as the position description? There is a – if I may short circuit, there is an assumption before this Commission that a PSEN2 would undertake PSEN1 duties, is that something you would expect as part of their role?---Yes, I guess so, yes.
PN598
Could you please turn three pages in, clause 64 the PSEN2 definition. I’d like to reacquaint yourself with that if you’re not already familiar with it. Are you familiar with that?---I am now, yes.
PN599
Okay can you identify to the Commission where in their duties that they would exceed this role and function?---Yes, certainly, I think if you look under the PSEN2 definition where it states:
PN600
This level represents the SFEN who work under the supervision of an RPN2 or an RPN as part of the nursing team.
PN601
Yes?---I don’t believe that the nursing staff that we are describing work under the direct supervision of an RPN.
PN602
But it doesn’t say direct in that definition does it?---It says supervision, I don’t believe that the way they’ve framed the award – I’m sorry I didn’t hear what you said.
PN603
It doesn’t say the word direct?---No, it doesn’t I stand corrected. But I don’t believe that the nursing staff here operate under the supervision of an RPN.
PN604
Evidence has been given to the Commission that they do, what do you say to that?---That perhaps you have a difference of opinion in regard to what supervision is.
PN605
Are these PSEN2’s responsible to the RPN?---As are the RPN2’s that work on the ward.
PN606
Well the RPN2 is a div 2 is it not?---No, no an RPN2 is a div 3.
PN607
Sorry, no an RPN2 sorry, now I’m with you yes. so that they answer to the shift leader I think it’s been characterised as or the unit manager?---They answer to, yes.
**** SID DONALD POPE XXN MR CORBOY
PN608
That’s fine, so they are under the unit manager’s supervision?---Not under the unit manager, that would be the shift leader would be the shift leader who they are answering to directly and whether answering to and being supervised in their practise is the same, I think we’d have a difference of opinion there.
PN609
So the shift leader is usually an RPN is that correct?---Always.
PN610
Always, so the shift leader they would answer to that person and we have a disagreement of whether they are being supervised or not?
PN611
THE DEPUTY PRESIDENT: RPN is for what?
PN612
MR CORBOY: Registered psychiatric nurse that’s the three year trained, div 1 div 3 has been referred to.
PN613
THE DEPUTY PRESIDENT: Division 1, division 3?
PN614
MR CORBOY: Division 1 or division 3, division 3 is a psychiatric branch and division 1 is the general branch.
PN615
THE DEPUTY PRESIDENT: Thank you.
PN616
MR CORBOY: So aside from supervision is there anywhere else where you believe that these nurses operate outside those descriptors?---Under typical duties.
PN617
Yes?---Under direction of an RPN or an SNP plan independently – implement and evaluate activities for clients within the bounds of PSEN knowledge. Again, from my knowledge of the way that the nurses in question practise that they are able to initiate those processes as opposed to doing it under direction.
PN618
Well evidence will be given to the Commission that the RPN is responsible for the nursing care plans on the wards?---Yes.
PN619
Or the shift leader then the manager responsible for those care?---They are responsible for the clinical practice within their unit certainly whilst they are in charge of the shift.
PN620
All right and evidence will be given that these staff members are working within their PSEN job role and function. Are you aware that evidence will be given today?---I’m not I wasn’t directly aware of the direct evidence no.
**** SID DONALD POPE XXN MR CORBOY
PN621
I’d like to turn your attention to the position description it is called DG3. Position description as you’d be aware is a document of a number of pages, can I turn your attention to page 2 client care clinical practices and standards. Now I’d like you to refresh your memory of that position description?---Is there a particular part you wanted me to refresh my memory?
PN622
I’d just like you to perhaps focus on client care and you’ve given evidence to this Commission that you believe they operate outside the job description, so I’d like you to point out where in that client care they operate outside?---I don’t think they vary from any of those descriptions, it doesn’t necessarily mean though that what they are doing is described here. So I guess if you’re talking about excluding the statements that are here under client care, the nurses in question they do, do all of the roles that are described under client roles.
PN623
Yes they do the roles that’s described client care?---But that doesn’t necessarily mean that that describes all of the things that they do whilst they are performing their roles.
PN624
No, well I’ve asked you to identify where their practice?---The level of independent practice that they engage in the amount of initiation and the initiative they show in their practice and their identifying of the needs of the client and the fact that they can do that without direction, and would do that without direct supervision, do that without being reviewed on a regular basis across the shift by the senior nurse in charge of the shift.
PN625
I take you back to the PSEN2 definition please clause 64. Now I’ve already established that the word direct supervision is
not incorporated in this
definition?---Yes.
PN626
I’ll take you down through that and we look at sub clause (a):
PN627
PSN’s at this level operate with relative independence but always under supervision of the RPN.
PN628
Is that controversial, do you agree that - - -?---I would suggest that the word, relative and the word, supervision again is something that we would need to clarify when it goes to our opinion as far as that’s concerned and definition of that. I don’t think that they operate with a relative independence, I think that they operate independently.
**** SID DONALD POPE XXN MR CORBOY
PN629
Well that’s actually contained within this definition, the word independently appears in more than one place in this definition, do you concede that?---I guess I’d have to concede it I haven’t read it at this point in time, I can’t see it directly in front of me at this moment.
PN630
If I may take you through?---Certainly.
PN631
There’s the independence in clause (a), clause (d):
PN632
Positions are expected to lead sessions independently.
PN633
Do you see that there?---Yes, I can see that.
PN634
And clause (e) there’s an expectation they may work independently under a direction of an RPN in community settings, so they can work independently in the community?---Under the direction of an RPN.
PN635
Yes, but that’s not - - -?---That’s when the RPN has decided that those people are generally stable, that the nurses in question are working in an acute psychiatric unit with people who have been recently if not directly admitted and may well be in acutely disturbed states.
PN636
Yes but that’s covered within this definition I would put to you that the definition covers complex, or complex clients?---It may well but again it doesn’t describe or discuss the relative independence that you’re describing in point (a), whereas I would assert that they operate independently and that there’s not a lesser level of independence when they practice when as opposed to the RPN2’s that they practice alongside.
PN637
So is it your evidence that they are equal to an RPN3?---The nurses in question in regards to the practice and when I was a shift leader, when I was assigning their clinical roles to them and when I was responsible for their practices within the unit, I treated them the same as I would treat an RPN2, so I would assert that in my day to day practice as a shift leader on the acute unit that I considered them to be the equivalent of an RPN2 yes.
PN638
But the RPN2 has a different job description and accountability do they not?
---Their accountability is to the shift leader the same as what the division 2 nurses are.
**** SID DONALD POPE XXN MR CORBOY
PN639
RPN2 which is a division 3 nurse?---Or a division 1 nurse.
PN640
Or a division 1 nurse, has got a different scope of practice and accountability is that correct?---That is correct.
PN641
Thank you and that scope of practice and accountability differs to the scope of practice of a PSEN1 or 2 is that correct?---That is not what I was arguing or asserting. What I was suggesting was that when I considered the three nurses that are here at this point in time, whilst I was performing the role of the shift leader, I didn’t differentiate between the div 2’s or the divisions 3’s or div 1 nurses in regards to the roles that they perform, the complexities of the clients that were assigned to them, or the expectations I had of them in regard to their practice.
PN642
That is your view from two years ago?---It’s longer than two years when I was practicing as a shift leader.
PN643
Okay so how long ago was that?---That would be closer to four years ago.
PN644
Four years ago, thank you for clarifying that. How about the issue of seclusion, can an SPEN2 seclude someone?---No and for that matter the decision made to initiate emergency seclusion is conducted by the shift leader or the senior nurse on duty at that time.
PN645
Okay?---So an RPN2 who was not the senior nurse on duty is unable to initiate seclusion either.
PN646
But an RPN2 if he or she was the senior nurse on duty could do that?---By definition if they were in charge of the ward, then they would be an RPN3 because that’s what the shift leader is employed as.
PN647
Okay?---But the definition under the Mental Health Act is it’s the senior psychiatric nurse on duty at the time.
PN648
So if an RPN2 is on duty and the unit manager or the shift leader is not present for whatever reason and they are the most senior nurse on the ward would they then have the capacity to seclude someone?---Yes, they’d satisfy the definition of being the most senior nurse on duty.
PN649
A PSEN2 does not have that capacity do they?---That’s correct.
**** SID DONALD POPE XXN MR CORBOY
PN650
Right okay just another question, your role at the hospital is now triage
nurse?---That’s correct.
PN651
Do you have any other roles at all?---Do I have any other roles at all?
PN652
Any other roles in the hospital?---I’m not sure what you’re referring to. I’m employed full time as a triage nurse that’s my substantive position.
PN653
Are the job representative for HSU?---I am.
PN654
You are?---Yes, in fact to be more precise I’m the president of the sub branch of the union in that local facility.
PN655
Okay thank you. Now in the activities that these nurses do, do you believe that they operate beyond the scope of practice as contained
within the nurses
board?---I’m sorry I thought I’d already answered that question. Can you - - -
PN656
I’m talking about the nurses board scope of practice?---All right I’m not familiar with the particular differences in regards to that.
PN657
Okay?---If you can enlighten I’d be more than appreciative.
PN658
Well most registered nurses operate within the scope of practice, there’s an extended scope of practice for div 2’s in
Victoria which encompasses things like the psychiatric course has been mentioned and there are also medication
courses?---Certainly, yes I’m aware of those additional skills that the nurses have trained in.
PN659
And evidence has been given it’s evolving so that are you aware at all from your knowledge that’s all, that these nurses have operated either within their scope of practice, or if not are you aware they operated beyond their scope of practice?---In regards to the extended - - -
PN660
In regards to their duties that you indicated that they are doing?---I’m not sure that I know what the question that you’re asking.
PN661
You’ve given evidence to the Commission that they operate beyond their PSEN2 role?---Yes.
**** SID DONALD POPE XXN MR CORBOY
PN662
Evidence I’ve already indicated will be contrary to that and what I’m asking you is in their extension of their duties beyond the PSEN2 role is it your opinion that they are still operating within the nurses board scope of practice?---Within the extended scope of practice I believe so, yes.
PN663
No further questions.
PN664
THE DEPUTY PRESIDENT: Thank you, any re-examination?
PN665
MS SVENDSEN: No I don’t think so thankyou your Honour.
THE DEPUTY PRESIDENT: Thanks very much thank you for giving evidence you’re excused.
<THE WITNESS WITHDREW [1.53PM]
PN667
THE DEPUTY PRESIDENT: Mr Corboy your witnesses?
PN668
MR CORBOY: For convenience I may call Mr Dunn because he is right beside me, your Honour.
THE DEPUTY PRESIDENT: Right.
<PHILIP JOHN DUNN, AFFIRM [1.54PM]
<EXAMINATION-IN-CHIEF BY MR CORBOY
PN670
MR CORBOY: Thank you Mr Dunn for the purposes of transcript could you please state your name and address?---Philip John Dunn (address supplied).
PN671
Have you prepared a statement and provided copies of letters to assist the Commission today?---Yes.
PN672
May I hand up your statement?---Yes.
PN673
THE DEPUTY PRESIDENT: It’s the same as the one filed is it or is it different?
PN674
MR CORBOY: Yes, it is your Honour.
PN675
THE DEPUTY PRESIDENT: It’s the same.
PN676
MR CORBOY: I’m in the habit of handing up statements.
PN677
THE DEPUTY PRESIDENT: No, no that’s fine as long as I know.
PN678
MR CORBOY: Mr Dunn is this the statement you helped prepare?---Yes.
PN679
Behind them there are three letters, one to Ms Jenny Watts, one to Ms Rosemary Kallasma and one to Ms Sandra Watts?---Yes.
PN680
Do you wish to make any amendments to your statement?---No.
PN681
You wish to table that today as part of your evidence?---Happy to.
Okay thank you, your Honour if I can tender that.
EXHIBIT #BARWON 1 WITNESS STATEMENT FOR PHILIP DUNN
PN683
MR CORBOY: Thank you, your Honour. Mr Dunn you’re obviously in a senior position at Barwon Health, has there been an opportunity where you’ve watched the practice of these three nurses today or you’ve been responsible for the practice of these three nurses today?---I’ve certainly worked alongside the three nurses many years ago when I was actively – clinically active I suppose as a nurse.
PN684
Part of the evidence today is that these three nurses work beyond what is expected within the PSEN2 job description and within the Barwon Health job description. Are you familiar with both documents?---Yes, I am.
**** PHILIP JOHN DUNN XN MR CORBOY
PN685
Could they be provided to Mr Dunn please? I’d ask you to familiarise yourself basically with clause 64, the PSEN2 definition and the accompanying job description?---I’m familiar with those.
PN686
Familiar with both of those okay. Regarding the PSEN position description what is your view regarding the activities of the three named applicants today and the PSEN2 definitions, do they exceed it or do they work within it?---They work well within it.
PN687
They work well within it. There is a position description, entitled psychiatric nurse division 2 level 2 Swanston Centre and it’s a number of pages, do you believe that the job that they do, or the work that they do is encompassed within that job description?---I do.
PN688
Right some comment has been made that this job description has not been revised since 2002. Do you believe the current document you have before you reflects the role that they do now?---I do, I believe in general terms it reflects the role, yes.
PN689
Thank you. Questions have been asked here particularly on the reporting arrangements it is your view that’s contained within your statement that the PSEN2’s work as a primary nurse but their responsible to the shift leader, is that correct?---That's correct.
PN690
Okay can you very briefly advise the Commission in quick terms where the differences is between perhaps an RPN and a PSEN2?---Well the difference in the mental health setting for – obviously the scope of practice is different. In particular in a mental health acute unit the capacity to act as the senior nurse on duty under the Act and to deal with very complex matters or very serious issues that arise can only defer to a division 1 or 3 nurse.
PN691
Right so there is that quite clear definition under the Act?---Yes.
PN692
Okay the issue has been raised about supervision how independently these nurses work, I refer you to the PSEN2 definition clause 64. The descriptions there about independently working do you believe that encompasses the work of the three applicants today?---I do believe it does, and I think the word independence is a relative independence is a term that describes the work that they do, but always under the supervision of an RPN and in the case of Swanston Centre the RPN shift manager.
**** PHILIP JOHN DUNN XN MR CORBOY
PN693
Right, now I refer you to the senior’s allowance handout or hand up that I’ll provide to the Commission which is clause 21.15 seniors allowance?---I don’t have that on me.
PN694
Perhaps the Commission can make that available. Second page in it goes across to the third page, are you familiar with this clause?---Yes, I am.
PN695
Okay is it your responsibility to authorise the senior’s allowance?---It’s my responsibility to administer the process and refer it to a seniors allowance committee.
PN696
In this process of administering have you sought what a seniors allowance is as far as the industry is concerned?---I certainly have I certainly obviously reviewed the EBA and the relevant provisions . I reviewed the classification standards within the EBA. I also talked to my senior colleagues around the states in regards to business practice I suppose and whether there were any examples that I may need to consider and obviously my senior colleagues within Barwon Health.
PN697
I refer you to 21.15(c) it’s got a variety of sub clauses there are five of them. Do you believe that the applicants today satisfy all those criteria?---No.
PN698
Questions have been asked in this Commission about the role of primary nursing, that the PSEN2 is being given the same allocation as an RPN. Can you briefly advise the Commission what this is about?---The model in Barwon is a model that tries to maintain the continuity of care of clients and as such the community based teams are linked with the acute unit so that staff within the unit are linked within a community based team. As such the continuity of the care that the4 client gets is maintained through their community and inpatient experience. As such primary nursing has been the terminology used here today, that means that the nurse has a direct responsibility for the client during their shift, but otherwise the system is supported by the shift manager and a team approach which also includes the consultant psychiatrist and case manager from the community.
PN699
Have you read the three witness statements from the applicants today?---Yes, I have.
PN700
Having seen those witness statements do you believe that each one works within the PSEN2 definition?---Yes.
**** PHILIP JOHN DUNN XN MR CORBOY
PN701
Do you believe that in those statements they work within the job description at Barwon Health?---Yes.
PN702
And within their scope of practice and the nurses board?---Definitely.
PN703
Thank you. Questions have been raised about the medication allowance or the endorsement for medication, can you please describe to the Commission whether this allowance and the psychiatric endorsed practice is contained within the scope of practice for a PSEN2?---Yes, it is.
PN704
On those two allowances do nurses get paid a sum of money or get extra fall back?---Under the EBA a nurse is only able to be paid one higher qualification allowance and - - -
PN705
So if a nurse has two higher qualifications, he or she only gets one
allowance?---They get one, they get the higher one.
PN706
They could get the allowance on either one, if they were medicating - - -?---They could get it on either one, but they take the higher one.
PN707
Now the medication is that administered under the general supervision of a RPN or a div 3 nurse?---General supervision. Everything in terms of nursing duties within the acute unit is under the general supervision.
PN708
The work that these nurses undertake in the award when they are allocated patients under primary care you believe is within their role as a PSEN2?---Yes.
PN709
Thank you, your Honour.
THE DEPUTY PRESIDENT: Any cross-examination?
<CROSS-EXAMINATION BY MS SVENDSEN [2.04PM]
PN711
MS SVENDSEN: Thank you, your Honour. Mr Dunn you’ve just described primary nursing, and the model about maintaining continuity with the community health term links with the units, the primary nursing direct responsibility for clients, otherwise supported by the team the shift leader, the consultant psychiatrist that applies to RPN2’s as well doesn’t it?---Yes.
PN712
You indicated that you had worked alongside all of the applicants today previously that was some time ago, wasn’t it?---A long time ago.
**** PHILIP JOHN DUNN XXN MS SVENDSEN
PN713
Do you believe that PSEN2’s are practising at the same level as they were 20 years ago?---20 years ago is a long time, the practice of every nurse, of every profession would mutate and modify but of course what goes along with that is practice standards, competencies and also the industrial instruments.
PN714
Have you seen the classification standards?---Yes, I have.
PN715
PSEN2 definitions that we’re referring to?---Yes.
PN716
Have they changed any in the past 20 years?---They are the current standards that are within the industrial EBA agreement.
PN717
They are the current standards in the industrial EBA agreement were they the standards that were in the agreement that was the industrial
instrument in
1986?---I’m not aware of that.
PN718
Many years ago you said you worked with them as PSEN2 how many years
ago?---It would have to be 20.
PN719
Do you know what the classification standards for a PSEN2 were at that
time?---No, I can’t recall that.
PN720
If I told you they were identical to the PSEN2 classification standards that we’re looking at in the current agreement you couldn’t say they weren’t, is that what you’re telling me?---I couldn’t dispute that because I don’t know what the standards were 20 years ago, no.
PN721
I actually have to admit that I failed to bring copies of this I’m really sorry.
PN722
THE DEPUTY PRESIDENT: We can make copies.
PN723
MS SVENDSEN: DG1 is the exhibit that it was labelled as under Denise Guppy.
PN724
THE DEPUTY PRESIDENT: Denise Guppy 1, okay thanks.
PN725
MS SVENDSEN: And attached to the statement.
PN726
THE DEPUTY PRESIDENT: So it’s in here is it?
**** PHILIP JOHN DUNN XXN MS SVENDSEN
PN727
MS SVENDSEN: So it is in the evidence.
PN728
THE DEPUTY PRESIDENT: Okay that’s fine.
PN729
MS SVENDSEN: It is in the information that you already have.
PN730
THE DEPUTY PRESIDENT: Thank you for that, DG1.
PN731
MS SVENDSEN: I will ask you to turn to the fourth page of those four pages Mr Dunn.
PN732
MR CORBOY: Excuse me your Honour if I may just inquire, my photocopy doesn’t have the DG1 on it, is it the document starting at 621 psychiatric state enrolled nurse?
PN733
MS SVENDSEN: It is yes, and at the bottom of that I think - - -
PN734
THE DEPUTY PRESIDENT: 29 October 1992.
PN735
MS SVENDSEN: Thank you. The footer refers to body of six of the manual. Page 4 psychiatric state enrolled nurse grade 2 PSEN2. This is the definition that comes out of what was then the – what is it called I remember it as a PSE – the personnel management manual which was where the public service determinations were recorded which determinate at that time the terms and conditions of employment including the classification standards for PSEN2 amongst others, PSEN1 and RPN’s as well. Would you compare those PSEN2 standards against the PSEN2 classification standards that you have from the current agreement?---On first scan they look the same, or very similar.
PN736
Would you be prepared to accept from me that they are essentially identical but for some very small changes which are identified in Ms Guppy’s statement?
PN737
MR CORBOY: Sorry your Honour I don’t have a copy of that page, mine finishes on - - -
PN738
THE DEPUTY PRESIDENT: Which page?
PN739
MR CORBOY: The page that is being referred to – thank you I have it now.
**** PHILIP JOHN DUNN XXN MS SVENDSEN
PN740
THE DEPUTY PRESIDENT: Thank you, go ahead Ms Svendsen. Ask the question again it may have been forgotten.
PN741
MS SVENDSEN: Would you be prepared to accept from me that those standards are essentially the same except for some minor differences such as the words, registered psychiatric nurse being detailed instead of abbreviated to RPN which is what is in our current classification?---I would be willing to accept that.
PN742
Would you say that the work of a PSEN2 has significantly changed since
1992?---I would suggest that the way this is described in 1992 in terms of conducting complex interviews, under the direction planning,
independently implementing and evaluating I think in general terms that continues to describe the work that PSEN2’s do today.
But the circumstances of their work and the models that they work under have obviously changed over 20 years. But the work that
they perform under the PSEN2 continues to be doing the work with complexity and with relative independence. So the fundamentals
of this remain the same, although nobody could argue that in 20 years circumstances haven’t modified and mutate.
PN743
How did the PSEN2 operate in 1992?---Well that’s a too wide a question I would suggest.
PN744
Didn’t they do what tasks they were set them?---PSEN2 at that time would have been doing this work, complex work.
PN745
You were here when the evidence was given that they weren’t doing that work in 1992 or as far back as that, that they were actually working task orientated and that they were working as directed specifically directed that there is a significant difference in the way that they operate now that they make the decision to take action or to raise a matter, they actually make those decisions?---They make those decisions, but that’s within their scope of practice.
PN746
Not arguing about their scope of practice, I’m talking about the classification standards and they are very different things are they not?---They are different but related this is the maximum - - -
PN747
Although they have – I am sorry Mr Dunn they are not related, the classification standards are an industrial instrument the scope of practice is a quality assurance and scope of practice for registration provisions under the Nurses Board Victoria and under the Australian standards?---I agree.
**** PHILIP JOHN DUNN XXN MS SVENDSEN
PN748
So the classification standards are not a scope of practice?---No.
PN749
You’ve indicated that you think that they practise very differently to what they did practise but now you’re saying that they don’t?---I don’t think I indicated that.
PN750
I think you did earlier you said that you thought they were practising very differently to what they did when you worked with them directly?---The models of service delivery have changed thankfully over 20 years. Their practise within those models remain consistent with the classification standards as they were then and as they are now.
PN751
Did they act as a primary nurse in 1992?---Well I can’t recall back 16 years how they were described, but if they were being paid as a PSEN2 in 1992 - - -
PN752
THE DEPUTY PRESIDENT: Sorry Mr Dunn just say yes or no if you don’t know just say you don’t know?---Well I don’t know, I can’t I don’t know.
PN753
So you don’t know if they were acting as primary nurses 20 years ago?---No I don’t.
PN754
MS SVENDSEN: Regardless of what they were called? I’m not actually asking about the term primary nurse, I’m actually asking about the concept that you’ve delivered in terms of maintaining continuity, the model?---Well - - -
PN755
Were they directly responsible for clients?---Back in 1992 I’m afraid I cannot make comment about that.
PN756
Thank you. You indicated that you administer the processes in relation to the seniors allowance committee?---Yes.
PN757
You’ve indicated in your letters to the nurses that you do a bit more than administer the process because you’ve indicated that if you don’t recommend a seniors allowance then it doesn’t get provided, isn’t that true?---That’s how I understood it at the time.
PN758
Is that not the case?---That’s not the case.
PN759
Okay thank you, in the evidence provided to us from by VHIA with Dr Kallarey’s statement there was an attachment E are you aware of that the senior allowance community terms of reference?---Yes, Cuddihy you’re talking about.
**** PHILIP JOHN DUNN XXN MS SVENDSEN
PN760
Thank you Cuddihy, thank you very much?---I was just about go ask you I’m not familiar with that Doctor.
PN761
Thank you. How new is this?---That was provided by Lucy the committee has been in existence for approximately 18 months. I’ve been a member of that committee.
PN762
Mr Dunn how new are these terms of reference?---I think they’ve been recently modified, but look I’m not familiar on how new they are.
PN763
If I told you that less than three months ago they weren’t on the intranet, would that surprise you?---It would surprise if there was no terms of reference on the intranet three months ago.
PN764
Apparently there was for a brief period of time, no terms of reference.
PN765
MR CORBOY: Your Honour sorry we can Dr Cuddihy with me that is on this. So I’m just wondering what the point is on this question.
PN766
THE DEPUTY PRESIDENT: All right.
PN767
MS SVENDSEN: I haven’t actually finished it.
PN768
In relation to scope of practice that you’re talking about here and the capacity to act as a senior nurse that RPN’s have that’s actually referring to seclusion under the Mental Health Act, is it not?---It is.
PN769
We’ve had a discussion here today about the concepts of supervision you indicated that everything on the ward was done under the general supervision of the shift leader. Can you define what you mean by general supervision?---Well the shift leader is responsible for the ultimately responsible for the clinical service delivery of that shift of that particular unit at the time. So in terms of ensuring that things are being done properly and comprehensively the shift manager is ultimately responsible. There are obviously elements to that, one element you’ve already alluded to in terms of capacity to seclude people to arrange and RPN’s are only able to monitor people in seclusion. There are documented policies and procedures that talk about having responsibility to monitor and ensure the person is on their correct risk assessment and overall manage the ward in terms of any issues that arise between any staff member who comes up, division 1, 2 or 3 to the shift manager.
**** PHILIP JOHN DUNN XXN MS SVENDSEN
PN770
Anybody who comes up to the shift manager, so we’re not talking about direct supervision of people’s task or work are we?---No shift manager can walk around and follow any particular nurse all day, no.
PN771
So when you say general supervision you mean I’m on the unit and I’ve got ultimate responsibility for what goes on?---Yes, and staff understand that if they have any concerns or issues or want to clarify or seek guidance that they’ll go to the shift manager for that.
PN772
So that has to be initiated by the nurses themselves, rather than the shift leader generally speaking to seek assistance?---That’s true but the shift manager also has a requirement to ensure that the risk assessment of all the clients on a particular unit is known to him or her and so if there’s any concerns about that risk assessment based on the shift manager’s observation or of that particular client then that would be challenged.
PN773
That is the case for all of the staff on the unit not just the PSEN2?---Yes.
PN774
So there’s no difference in the responsibilities to the PSEN2 in their general supervision than there is to the RPN2’s because a shift leader is still responsible for seclusion for RPN2’s as well aren’t they?---Yes, but every nurse works within their scope of practice.
PN775
They do work within the scope of practice at least I hope they do. The dictionary meaning supervise says Mr Dunn:
PN776
Direct or inspect work or workers or the operation of an organisation.
PN777
Operation of an organisation I will agree that they are supervising the operation of the unit but are they actually directing or inspecting the work? They are not directing it are they?---Not on a minute by minute basis, no.
PN778
Thank you no further questions at this time.
PN779
THE DEPUTY PRESIDENT: Any re-examination?
**** PHILIP JOHN DUNN XXN MS SVENDSEN
PN780
MR CORBOY: Just briefly.
<RE-EXAMINATION BY MR CORBOY [2.21PM]
PN781
MR CORBOY: You indicated that nurses operate within their scope of practice, is each nurse accountable or responsible for their own practice under their registrations?---Yes.
PN782
So this goes with any nurse - - -
PN783
THE DEPUTY PRESIDENT: Don’t lead.
PN784
MR CORBOY: Sorry, so sorry.
PN785
Does this responsibility apply to any nurse?---Yes.
PN786
That’s registered, okay thank you. And questions have been asked about the allocation of duties can you advise the Commission when these duties are delegated would the unit manager have in mind the scope of practice or duties that nurse when delegating?---The shift manager would have this scope of practice of every nurse in mind and – but as we’ve already heard evidence the model at Swanston Centre is allocated on a team basis not on a complexity basis.
PN787
Right no further questions.
THE DEPUTY PRESIDENT: Terrific thanks, thank you very much for giving evidence , you’re excused.
<THE WITNESS WITHDREW [2.22PM]
PN789
THE DEPUTY PRESIDENT: Right next witness. What is your finishing time, Mr Corboy?
PN790
MR CORBOY: 2.45 is desirable your Honour.
PN791
THE DEPUTY PRESIDENT: Well have two witnesses to get through in 20 minutes in that case.
PN792
MR CORBOY: Can we have Mr Sean Duffy, your Honour.
THE DEPUTY PRESIDENT: All I can say if we’re going to finish today people will have to be brief, but it’s a matter for the parties or to use the modern term, stakeholders.
<SEAN MICHAEL DUFFY, SWORN [2.23PM]
<EXAMINATION-IN-CHIEF BY MR CORBOY
PN794
MR CORBOY: For the purposes of the transcript Mr Duffy, can you state your name and your address where you can be contacted please?---My name is Sean Michael Duffy and (address supplied).
PN795
Thank you have you assisted in preparing a statement for today?---Yes.
PN796
I’d like to hand that statement up to you. Are there any additions or corrections?
---No.
PN797
That’s part of your evidence today?---Yes.
PN798
Thank you, your Honour.
THE DEPUTY PRESIDENT: Right.
EXHIBIT #BARWON 2 WITNESS STATEMENT OF SEAN DUFFY
PN800
MR CORBOY: Mr Duffy you’re currently the program manager can you advise the Commission whether you are familiar with the work of the three applicants today?---Yes I am.
PN801
On what basis are you familiar with that?---I’m the program manager for the acute unit they work, so I directly and indirectly supervise that unit.
PN802
All right have you read the three witness statements provided by the applicants today?---Yes, I have.
PN803
In reading those do you believe that the nurses involved are operating within their position description?---Yes.
PN804
Is it your evidence today that they are operating within the PSEN
definition?---Yes.
PN805
How familiar are you with the PSEN definition? When did you last view
it?---When did I last sorry?
PN806
When did you last view the PSEN definition?---Today.
**** SEAN MICHAEL DUFFY XN MR CORBOY
PN807
Today okay may I ask that it be handed up to this witness. I may draw your attention to clause 64 which is following clause 63, the PSEN definition. Can you familiarise yourself with that clause please?---64?
PN808
64?---Yes.
PN809
Right now the evidence you’ve already given is that you believe the nurses work within that range of duties?---These features 64(1)?
PN810
Yes these features and also the typical duties on the following page?---Yes.
PN811
Would you expect all PSEN2’s in your unit or program to follow these particular range of duties?---I would expect them all to work within these duties.
PN812
Okay can you look at the job description for the PSEN2? Can you familiarise yourself or just reacquaint yourself with that position description?---Yes.
PN813
Do you believe this position description encompasses the range of duties that are currently being undertaken by PSEN’s the applicants today?---Yes.
PN814
Does it differ from any other expectation of any other expectation of any other PSEN2?---No.
PN815
That is all thank you.
THE DEPUTY PRESIDENT: Thanks, Ms Svendsen.
<CROSS-EXAMINATION BY MS SVENDSEN [2.27PM]
PN817
MS SVENDSEN: Mr Duffy do you work directly on the unit with these
nurses?---My office is off the unit, same building but off the unit yes.
PN818
Have you worked directly on a unit as a shift leader over a PSEN2?---I have worked in the unit on a couple of shifts, yes. I wasn’t a shift leader that particular night but I have worked there, yes.
PN819
Have you worked in any other units with PSEN2’s?---Yes.
PN820
You indicate in your statement at the top of page 2 that the PSEN’s are:
**** SEAN MICHAEL DUFFY XXN MS SVENDSEN
PN821
They cannot and don’t complete nursing functions that are consistent with an RPN or within the scope of practice of an RPN.
PN822
Do you stand by that statement?---Yes, I do.
PN823
I will provide you with the RPN2 position description for Barwon Health, acute unit I haven’t previously provided this through the Commission. You have a copy of the Barwon Health PSEN2 position description?---Yes.
PN824
Can you go through these two position descriptions and tell me what’s the
difference?---Can I write on this? No. Can I make the first point in the position purpose a registered psych nurse can in the absence
of a shift manager act in charge of the unit. That’s the first and primary point of difference. Under clinical practice standards,
to take shift management responsibilities.
PN825
Sorry under - - -
PN826
THE DEPUTY PRESIDENT: Page 2, clinical practice standards, first dot point.
PN827
MS SVENDSEN: Yes?---Under clinical practice standards point 2 complete competency evaluation.
PN828
THE DEPUTY PRESIDENT: That’s it?---That’s it. Okay thanks, next question.
PN829
MS SVENDSEN: So they can’t act as shift managers, something that we’ve acknowledged right from the start, can’t take shift responsibility in accordance with section 13.13 in appendix A of the psychiatric services agreement, I think actually it really is supposed to refer to the Medical Health Act, but anyway and competency evaluation is actually present in the PSEN position description but at a different spot and I’ll actually find that and go back to it in a moment. So principally the difference between the PD’s for the two sets of people we’re talking about one, trained for one years and one trained for three years, is not acting in charge?---Then the responsibilities that lie within that.
PN830
I’m actually not arguing that being in charge of a shift is you know a lot of responsibility or not a lot of responsibility I understand that it is. But there’s not a lot of difference in the expectations of an RPN2 when they are not in charge of a shift as there is in the expectations of your PSEN2?---Well the Mental Health Act particularly does clearly distinguish that there is a big difference.
**** SEAN MICHAEL DUFFY XXN MS SVENDSEN
PN831
It does for seclusion purposes we have acknowledged that?---And restraint.
PN832
You say further down in dot point it would be the dash point 2 about halfway through that:
PN833
Admission, case load management and discharge processes are sanctioned, supervising, closely monitored by the shift manager.
PN834
Direct supervision?---Sorry let me find the point.
PN835
It’s about halfway through that paragraph maybe a bit higher than that.
PN836
THE DEPUTY PRESIDENT: Paragraph beginning what words?
PN837
MS SVENDSEN: In regards to the decision making ability of the PSEN2.
PN838
THE DEPUTY PRESIDENT: I see yes, and what are the words?
PN839
MS SVENDSEN: It is about the third sentence:
PN840
These functions may seem relatively independent however like all staff within the Swanston Centre, all admissions, case load management and discharging processes are sanctioned, supervised and closely monitored by the shift manager.
PN841
Direct supervision?---Correct.
PN842
Evidence has been given here today that it is not direct supervision ion any way shape or form, direct supervision means you participate with me to do something, not at some distance?---When I say direct supervision that means that I’m observing what a person does.
PN843
How can you observe what a person does in a discharge plan if you’re not actually participating in it?---But they do participate in it.
PN844
So it would surprise you to discover that the witnesses have given evidence that they do the discharge planning not with their shift leader, but they do the discharge planning as part of their duties?---Well, in regard to discharge planning that they are directly supervised, they are also indirectly supervised by the consultant psychiatrist.
**** SEAN MICHAEL DUFFY XXN MS SVENDSEN
PN845
Maybe you could tell me the difference between direct supervision and indirect supervision in your mind?---Okay, direct supervision is an example of that is that if a person is working on a unit or an a ward that they have a person who is working with them for the duration of their shift. Who watching them, working with them, assisting them in making decisions. A person who is directly available at all times for a person to go to within the same environment, that’s how I would look at direct supervision.
PN846
Directly go to if you want some assistance is very different to directly supervise and monitor what an individual is doing?---I would describe direct supervision as having constant contact with a person, having constant contact with a supervisor, being able to watch what a person does, being able to see what a person does. To me indirect supervision is where by like my position as a program manager periodically goes into the unit, indirectly supervises through a nursing unit manager, isn’t in the unit all of the time, similar to what some of our Doctors for example are in and out of the unit, they are providing indirect supervision to the care. Direct supervision for me is that constant availability of a supervisor in the same location as where you’re working.
PN847
So none of the practitioners in the unit except the shift leader, practise independently?---I don’t think anyone practises independently. I mean it does depend on how we define independent is, but they all work within a team. The RPN’s work in a team, so do the PSEN’s they work in a team.
PN848
Do they make independent decisions?---No.
PN849
Thank you, that surprises me significantly. Do you know what sort of supervision is provided to given your understanding of supervision, provided to PSEN’s administering medication?---Supervision, each of the people who are endorsed to give medication will go to a medicine cupboard and they would administer off the treatment sheet, so that they could do that – they don’t have to be observed one on one with whoever the shift manager is they can go into and administer that to the patient.
PN850
You’ve indicated at the last in the last paragraph which commences:
PN851
It is acknowledged that the PSEN’s partially complete the role of preceptor.
PN852
Can you define partially for me? What don’t they do?---They don’t sign off on competency, final competency assessments of undergraduate students.
**** SEAN MICHAEL DUFFY XXN MS SVENDSEN
PN853
Who does?---Registered nurses.
PN854
I put it to you that it’s the clinical educators that sign off on their
competency?---Some registered nurses sign off on competencies.
PN855
The shift leaders?---I don’t know, I don’t know whether they do or not. Usually it would be the registered nurses who are preceptors, in the absence of that it would be the clinical educator. So partial to me means that they can watch they can make comments about students, they can support students, they can educate students, but they can’t sign off on final year competencies of students who are on rotations and they don’t routinely.
PN856
Which is a requirement of who?---Universities.
PN857
Yes. No further questions.
THE DEPUTY PRESIDENT: Any re-examination.
<RE-EXAMINATION BY MR CORBOY [2.40PM]
PN859
MR CORBOY: In looking at the position description that’s been provided to you of a PSEN can you, I turn your attention to page 3 the first dot point - seen principal practise surrounding the delivery and management of ETC to patients. This is for the RPN2?---That’s right RPN2, yes.
PN860
Does a PSEN get involved with delivery of ETC?---No.
PN861
Thank you. You’ve been asked about supervision of students or the role of preceptor can you advise the Commission if the PSEN’s would supervise all students and if they don’t are there any limitations?---What do you mean all students?
PN862
Well I gather there is a student in the first year course, the second year course and the third year course, I believe it is a three year course?---That’s right.
PN863
Rotation occurs, that’s my understanding?---Yes.
PN864
So can you advise the Commission from your understanding of what level of student the PSEN would supervise?---They wouldn’t supervise a third year student.
**** SEAN MICHAEL DUFFY RXN MR CORBOY
PN865
They would not?---They would not to the point of signing off and endorsing their competency on that placement.
PN866
That’s all your Honour.
PN867
THE DEPUTY PRESIDENT: Thank you very much for giving evidence.
MS SVENDSEN: Sorry excuse me your Honour I’m really sorry.
<FURTHER CROSS-EXAMINATION BY MS SVENDSEN [2.42PM]
PN869
MS SVENDSEN: But having a current understanding of principals and practice surrounding the delivery and management of ECT isn’t ECC outsourced and none of the RPN’s get involved in the delivery of ECT either?---We have RPN’s who are involved in the delivery of ECT.
PN870
Isn’t it outsourced and people who are not in the unit, people in the unit don’t get involved in the delivery of ECT?---The ECT treatments are done outside of the unit, correct.
PN871
Thank you.
THE DEPUTY PRESIDENT: Thank you very much for giving evidence.
<THE WITNESS WITHDREW [2.43PM]
PN873
MR CORBOY: I’d like to call Dr Cuddihy.
THE DEPUTY PRESIDENT: While that’s going on I’ll mark the statement.
EXHIBIT #HSU6 BARWON POSITION DESCRIPTION FOR RPN2
<LUCY PATRICIA CUDDIHY, SWORN [2.43PM]
<EXAMINATION-IN-CHIEF BY MR CORBOY
PN875
MR CORBOY: Dr Cuddihy for the purpose of the transcript, could you restate your name and address where you can be contacted please?---Lucy Cuddihy, (address supplied).
PN876
Thank you, have you assisted in preparing a witness statement today?---I have.
PN877
Does that witness statement have a number of attachments which I may characterise as policy and procedures?---Yes, I have.
PN878
I would like to hand up that statement to you. Now Dr Cuddihy attached to your statement – sorry are there any amendments to your statement that you wish to make?---No not this one.
PN879
All right if I may ask you some questions about your statement.
THE DEPUTY PRESIDENT: Sorry is it true and correct your statement?---True my statement is true and correct.
EXHIBIT #BARWON 3 WITNESS STATEMENT OF DR LUCY CUDDIHY
PN881
MR CORBOY: Thank you, your Honour. Now I gather you’re professionally responsible for the nursing practice at Barwon?---That is my responsibility yes.
PN882
Have you been involved in the evolving role of the PSEN and SEN at
Barwon?---I’ve worked at Barwon Health for three years and during that period of time I have been actively engaged in developing
the workforce and in particular looking at the role of the division 2 nurses and PSEN.
PN883
Can you advise the Commission how many division 2 and or roughly how many division 2’s and how many PSEN’s there are at Barwon?---Just under 500 around about 497 at last count.
PN884
Right thank you and do you acknowledge that there is a difference in role and function between a PSEN2 and a PSEN1?---Between PSEN2 and PSEN1 yes there is a difference.
PN885
I’d like to hand up the 63 and 64 as well as position descriptions for the PSEN.
**** LUCY PATRICIA CUDDIHY XN MR CORBOY
PN886
THE DEPUTY PRESIDENT: I think they’re up there.
PN887
MR CORBOY: I’d like you to just have a look at the document within that is entitled section 63 and three pages in there’s a clause 64?---I’m sorry I don’t think that’s right I’ve got clause 64 three pages in.
PN888
I think it’s two or three pages in? A nurse who is engaged – this comes from the EBA – a nurse who is engaged at Barwon Health in a psychiatric unit would you believe or expect them to operate within those guidelines and features?---Yes.
PN889
You would expect nurses to work within their scope of practice as
outlined?---Yes.
PN890
By the various nursing bodies okay. Attached to your statement there are a number of policies and procedures they are quite extensive, they go to medications, the position description, the role or guidelines of a psychiatric nurse, the guidelines of seniors allowance et cetera, are these all current policies at Barwon?---They are.
PN891
Unfortunately, it’s not numbered, but I’d like you to go to attachment E, its about five pages, six pages from the back, and it’s called senior allowance committee terms of reference?---I have that.
PN892
Can you advise the Commission how long these terms have been in operation?---I revised this committee in 2006 I believe. These should have a date of review on them this particular set of terms of reference. They come from – they haven’t come off our current comp system, but these were revised, I revised them I chair that committee, and the committee, I’ve set it up so that it meets quarterly and the nursing directors and HR meet in order to review any applications we have.
PN893
Right so your recollection is that they’ve been in place since at least 2006?---Yes.
PN894
Was there a previous term of reference or previous committee involved?---I’m sorry I can’t really comment on what was exactly there beforehand, there was as I understand a seniors committee I know what I put in place in terms of reviewing the previous approach, but certainly I set this one up very clearly.
PN895
Thank you, evidence has been given today about the applicants being involved in a program regarding an extended practice and speaking at various conferences, can you advise the Commission of your role in this process?---In 2005 there was an opportunity to work with the department of human services nurse policy branch in looking at the division 2 role within the health services. I was relatively new to the organisation at that time and it seemed very clear to me that the relationship between the division 2 working force within our mental health program was very strong. There had been significant education or preparation of the division 2 workforce in the mental health program so educationally management wise it was a good area for me to look at working within that group around medication endorsement which was a new initiative at that particular period. I applied for a grant it was successful, established a committee which had union, management and division 2 representation, I chaired the committee. The project was in place for 18 months, I applied for a number of grants under that particular funding opportunity and encouraged the division 2 nurses to speak both at local conferences, at national conferences and at international conferences on their experience of medication endorsement and in fact participated in significant project.
**** LUCY PATRICIA CUDDIHY XN MR CORBOY
PN896
Is that project continuing?---The project completed and what has continued is the continual framework that we established around medication endorsement for the division 2 workforce.
PN897
So if I understand it correctly the project set up the framework?---Correct.
PN898
Now the project has completed?---That’s right.
PN899
So its not a regular and ongoing project?---No. It’s now part of the practice and the framework is what is established.
PN900
Thank you, now the medication endorsement this is a new area for div 2
nurses?---yes.
PN901
Can you advise the Commission what your awareness is as far as the scope of practice and the nurses board, for division 2 nurses?---The nurses board is very clear about scopes of practice they refer back to the national competency standards which are set by the Australian Nursing Council and the Nurses Board of Victoria do not have a separate set of competency standards. They accept the national competency standards and the scope of practice for the division 2 registered nurse and PSEN is to work under direct supervision to the registered nurse. Now there are various ways that that occurs and their competency standards talk about those different ways that that occurs. Primarily what I would see from an organisation point of view, is that and it’s quite clear in the competency standards as well, is that the division 2 workforce and the PSEN in this particular case too can engage in significant nursing care practices. At all times though they communicate with the overall division 1 or the registered nurses in charge and that does not mean that you spend your entire day communicating with them. But it does require you within your scope of practice to maintain that communication about significant matters associated with patient care and that is written in a range of different ways. If you go to section 4 I think of the Australian Nursing Council competencies you will see a particular segment there that makes it fairly clear.
PN902
Nurses that have medication endorsement if I may just – the nurses that have medication endorsement current, with your understanding of the current Nurses Board scope of practice with that endorsement they are still operating within that scope is that correct? So that if a nurse has a medication endorsement he or she is still operating within that PSEN, SEN scope of practice?---Yes the division 2 workforce who are medication endorsed are endorsed for certain drug groups.
**** LUCY PATRICIA CUDDIHY XN MR CORBOY
PN903
THE DEPUTY PRESIDENT: It means they can administer certain drugs direct to clients?---Correct.
PN904
MR CORBOY: And just one more question, my understanding is previously this was a module, can you advise the Commission of what you know about the current basic training of SEN’s?---There’s a new call of new educational training program under the new qualifications framework and within 12 months the division 2 nurses will be graduating with being medication endorsed as opposed to the current situation where we have very significant part of the workforce commissioned to the workforce that are not medication endorsed. Currently there are around about 100 nurses in Barwon Health that are medication, have medication endorsement with the Nurses Board of Victoria.
PN905
Thank you, your Honour.
THE DEPUTY PRESIDENT: Thanks Ms Svendsen.
<CROSS-EXAMINATION BY MS SVENDSEN [2.55PM]
PN907
MS SVENDSEN: Dr Cuddihy you referred to the extended scope of practice project that you started in 2005, it was called an extended scope of practice, PSEN scope of practice or division 2 I think actually?---Division 2.
PN908
Extended scope of practice you indicated that the work you focused on was around medication endorsement, that it established a medication endorsement framework, and that those nurses continue to practise in an extended scope of practice?---The project from the nurse policy branch was named that and so that is the reason for the title of the project. So that was the funding that we sought, that was the grant opportunity and that was the name of the funding line, so that’s the reason it’s named that.
PN909
Did it extend the scope of practice of the PSEN’s who undertook medication endorsement?---At that particular time, it did yes.
PN910
Doesn’t it any longer?---It was a project and we needed to find a way in the organisation to have the division 1 workforce the division 3 workforce as well as the division 2 workforce understand this new environment and understand their responsibilities within that.
PN911
Does the extent of the scope of practice actually continue or not?---Of I think there were about 497 division 2 nurses that I said are employed about 100 of those currently are medication endorsed so there have been some extensions to the overall workforce’s practises, yes.
**** LUCY PATRICIA CUDDIHY XXN MS SVENDSEN
PN912
You indicated that you revised the committee in 2006?---Yes.
PN913
You gave evidence that that was when you revised the terms of reference and that these terms of reference that were attached to your statement were the ones ion 2006, is that correct?---They are the current ones.
PN914
When were these last revised?---They were reviewed about a month ago, or six weeks ago.
PN915
Thank you.
PN916
THE DEPUTY PRESIDENT: Sorry does review mean changed?---They were reviewed because they were not clear about that particular framework - - -
PN917
So you altered them?---Also included the PSEN, there was some confusion around the division 2 workforce and it’s intent.
PN918
MS SVENDSEN: Your Honour if I could provide you with sorry – the guidelines that you already have SW11 tab at the Barwon seniors guidelines. Sandra Watts, SW11 I think it is the last attachment.
PN919
THE DEPUTY PRESIDENT: Yes, I have it, you don’t. I tell you what I’ll hand mine to the witness to save time, shall I?
PN920
MS SVENDSEN: Thank you, your Honour.
PN921
THE DEPUTY PRESIDENT: I’ll need it back though.
PN922
MS SVENDSEN: Dr Cuddihy these were the terms of reference that the PSEN’s that are applicants in this matter actually used to apply because they were the terms of reference that were available which refer only to the nurses award and not the mental health agreement?---I understand that is correct.
PN923
So that, when you are referring to some confusion there were no guidelines for seniors allowance for mental health enrolled nurses, division 2 nurses?---It’s not entirely accurate because the committee comprised representatives from Mental Health. They were at the table and so therefore the guidelines included the mental health program even though the terms of reference didn’t specifically state it they certainly were meant to include the PSEN workforce and they were also represented at the table, by the director of mental health program.
**** LUCY PATRICIA CUDDIHY XXN MS SVENDSEN
PN924
Did any of those applications go up to that committee?---I’m – I don’t believe any came from the mental health program however it was discussed broadly within that committee the matter of medication endorsement and the entitlement that would exist in Barwon Health for medication endorsement and so therefore by definition they were ineligible to be received.
PN925
Was medication endorsement the only reason given in relation to the application for these senior allowances?---It was a matter that was discussed significantly at the table at the time.
PN926
So the rest of their application which included that they also had mental health endorsement and had other training and higher responsibilities none of that was discussed at the committee is that what you are telling me?---The role of the PSEN in the Swanston Centre was discussed, that’s my memory that it was discussed and also because at that particular time we had the project in place, then we were talking about the various, there were a number of roles we trialled through that project and we were discussing all of the aspects associated with that particular project. That is my recall of the meetings that occurred in 2006.
PN927
So it didn’t go – well you’ve already said that the applications weren’t put up so it didn’t go to the issues that they themselves have raised. I’m a little bit confused, I just need to clarify this. You indicated that medication endorsement provided – sorry division 2 nurses with the ability to administer certain drugs doesn’t it provide them with the ability to administer drugs through certain routes?---Correct currently.
PN928
Not certain drugs?---It’s certainly through certain routes and yes.
PN929
THE DEPUTY PRESIDENT: What you mean syringe, pill or whatever?
PN930
MS SVENDSEN: The current medication endorsement goes for to intramuscular and subcutaneous and oral and topically ones, but not intravenous?---And I might say at this particular time the subcutaneous and the intramuscular so the educational programs are available they are not being delivered in Barwon Health because there’s another very significant piece of work to be undertaken there.
PN931
Would you be surprised to discover that PSEN’s behind me administer IM and subcutaneous injections?---I’d need to have that clarified. I understand that they are endorsed but I don’t understand – I would need to refer to the director’s programs.
**** LUCY PATRICIA CUDDIHY XXN MS SVENDSEN
PN932
Their statements actually refer to the fact that they do since they’ve undertaken those additional modules. Sorry Commissioner
the additional module was there was actually it has been split up as it’s been added to the scope of
practice?---That’s right it has.
PN933
In relation to the work that the PSEN’s perform on Swanston unit, you actually take that on the advice of other staff don’t you, you haven’t actually worked with them or worked on the unit, or worked in mental health?---No, I haven’t worked in the unit, and I certainly haven’t worked in mental health but I have made sure that I have visited the unit and In fact I understand the way the program works. In order to entirely understand the way the program works I needed to spend time inside both the acute program and in other aspects of the overall program.
PN934
Dr Cuddihy thank you I have no further questions at this time.
THE DEPUTY PRESIDENT: Thank you, any re-examination?
<RE-EXAMINATION BY MR CORBOY [3.04PM]
PN936
MR CORBOY: Dr Cuddihy before you, you have got Sandra Watts statement I believe?---Which one sorry?
PN937
With the attachments, I believe you’ve been referred to page 23 of that?---I am on that.
PN938
I’d like you to turn over the page to page 24 its’ got the criteria issued by Commissioner Blair in 31 August 2000. Can you advise the Commission whether this was part of the consideration for senior’s allowance?---It was.
PN939
You’ve been asked about Sandra Watts’ application can you turn to page 11 please. In that application if I stand to be corrected, but it seems to be based upon her ability to administer medications? Is that a fair summation of that application?---That’s as I read that particular application yes.
PN940
That’s the application dated 29 May 2006?---Correct.
PN941
Okay and you were asked about would you be – have knowledge of the applicants today giving IM medications, which I assume is intramuscular?---That’s correct.
PN942
From your knowledge of the scope of practice of an endorsed medication nurse, is this within the current guidelines?---It is within the current guidelines, yes that’s right.
**** LUCY PATRICIA CUDDIHY RXN MR CORBOY
PN943
So if a nurse has done the course they can administer?---Correct they are.
PN944
No further questions your Honour.
THE DEPUTY PRESIDENT: Terrific thank you very much for giving evidence you are excused, you can leave that document behind thank you.
PN946
THE DEPUTY PRESIDENT: Right now we come to the issue of written submissions which has been raised, we’ll go off transcript to deal with that.
<OFF THE RECORD
PN947
THE DEPUTY PRESIDENT: We’ve discussed procedure the applicant HSU will provide written submissions four weeks from today. Barwon will respond four weeks from that and then the HSU will have one week to respond tot hat and the matter and will be heard and determined on that basis. I’ll just add one final thing which is whatever the decision that is made, and I have no idea at this stage what the decision will be, it is of course no reflection on the competence or professionalism of the three nurses concerned or of the managers of Barwon, all right, I just wanted to make that clear. So thank you very much for those submissions I’ll give them careful consideration.
<ADJOURNED ACCORDINGLY [3.09PM]
LIST OF WITNESSES, EXHIBITS AND MFIs
DENISE FAYE GUPPY, AFFIRMED PN94
EXAMINATION-IN-CHIEF BY MS SVENDSEN PN94
EXHIBIT #HSU1 WITNESS STATEMENT OF DENISE FAYE GUPPY PN97
CROSS-EXAMINATION BY MR CORBOY PN104
RE-EXAMINATION BY MS SVENDSEN PN132
THE WITNESS WITHDREW PN150
DENISE FAYE GUPPY, RECALLED ON FORMER AFFIRMATION PN172
RE-EXAMINATION BY MS SVENDSEN, CONTINUING PN173
FURTHER CROSS-EXAMINATION BY MR CORBOY PN181
THE WITNESS WITHDREW PN184
JENNY LYNN WATTS, AFFIRMED PN193
EXAMINATION-IN-CHIEF BY MS SVENDSEN PN193
EXHIBIT #HSU2 WITNESS STATEMENT OF JENNY LYNN WATTS PN200
CROSS-EXAMINATION BY MR CORBOY PN224
RE-EXAMINATION BY MS SVENDSEN PN350
FURTHER CROSS-EXAMINATION BY MR CORBOY PN374
THE WITNESS WITHDREW PN387
SANDRA GAYLE WATTS, AFFIRMED PN389
EXAMINATION-IN-CHIEF BY MS SVENDSEN PN389
EXHIBIT #HSU3 WITNESS STATEMENT OF SANDRA GAYLE WATTS PN392
CROSS-EXAMINATION BY MR CORBOY PN401
RE-EXAMINATION BY MS SVENDSEN PN466
FURTHER CROSS-EXAMINATION BY MR CORBOY PN477
THE WITNESS WITHDREW PN485
ROSEMARY JOY KALLASMAE, AFFIRMED PN490
EXAMINATION-IN-CHIEF BY MS SVENDSEN PN490
EXHIBIT #HSU4 WITNESS STATEMENT OF ROSEMARY JOY KALLASMAE PN493
CROSS-EXAMINATION BY MR CORBOY PN494
RE-EXAMINATION BY MS SVENDSEN PN548
FURTHER CROSS-EXAMINATION BY MR CORBOY PN553
THE WITNESS WITHDREW PN564
SID DONALD POPE, AFFIRMED PN570
EXAMINATION-IN-CHIEF BY MS SVENDSEN PN570
EXHIBIT #HSU5 WITNESS STATEMENT OF SID POPE PN575
CROSS-EXAMINATION BY MR CORBOY PN577
THE WITNESS WITHDREW PN666
PHILIP JOHN DUNN, AFFIRM PN669
EXAMINATION-IN-CHIEF BY MR CORBOY PN669
EXHIBIT #BARWON 1 WITNESS STATEMENT FOR PHILIP DUNN PN682
CROSS-EXAMINATION BY MS SVENDSEN PN710
RE-EXAMINATION BY MR CORBOY PN780
THE WITNESS WITHDREW PN788
SEAN MICHAEL DUFFY, SWORN PN793
EXAMINATION-IN-CHIEF BY MR CORBOY PN793
EXHIBIT #BARWON 2 WITNESS STATEMENT OF SEAN DUFFY PN799
CROSS-EXAMINATION BY MS SVENDSEN PN816
RE-EXAMINATION BY MR CORBOY PN858
FURTHER CROSS-EXAMINATION BY MS SVENDSEN PN868
THE WITNESS WITHDREW PN872
EXHIBIT #HSU6 BARWON POSITION DESCRIPTION FOR RPN2 PN874
LUCY PATRICIA CUDDIHY, SWORN PN874
EXAMINATION-IN-CHIEF BY MR CORBOY PN874
EXHIBIT #BARWON 3 WITNESS STATEMENT OF DR LUCY CUDDIHY PN880
CROSS-EXAMINATION BY MS SVENDSEN PN906
RE-EXAMINATION BY MR CORBOY PN935
THE WITNESS WITHDREW PN945
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