Public
Health System Nurses' & Midwives' (State) Award
INDUSTRIAL RELATIONS
COMMISSION OF NEW SOUTH WALES
Application by New South
Wales Nurses' Association, Industrial Organisation of Employees.
(No. IRC 2165 of 2007)
Before Commissioner
McLeay
|
18 December 2007
|
VARIATION
1. Delete clause
53, Reasonable Workloads for Nurses, of the award published 24 February 2006
(357 I.G. 345) and insert in lieu thereof the following:
53. Reasonable
Workloads for Nurses
(i) To assist in
providing a sustainable health system for the people of NSW that not only meets
present health needs but also plans for the health needs of the future,
reasonable workloads for nurses are required. The employer has a responsibility
to provide reasonable workloads for nurses.
(ii) Reasonable
workload principles
The following principles shall be applied in
determining or allocating a reasonable workload for a nurse:
(a) the workload
assessment, based on the agreed tools or agreed principles and guidelines, will
take into account measured demand by way of clinical assessment, including
acuity; skill mix, including specialisation where relevant; and geographical
and other local requirements/resources;
(b) the work
performed by the employee will be able to be satisfactorily completed within
the ordinary hours of work assigned to the employee in their roster cycle;
(c) the work will
be consistent with the duties within the employee's classification description
and at a professional standard so that the care provided or about to be
provided to a patient or client shall be adequate, appropriate and not
adversely affect the rights, health or safety of the patient, client or nurse;
(d) the workload
expected of an employee will not be unfair or unreasonable having regard to the
skills, experience and classification of the employee for the period in which
the workload is allocated;
(e) an employee
will not be allocated an unreasonable or excessive nursing workload or other
responsibilities except in emergency or extraordinary circumstances of an
urgent nature;
(f) an employee
shall not be required to work an unreasonable amount of overtime;
(g) an employee's
workload will not prevent reasonable and practicable access to Learning and
Development Leave, together with `in-house' courses or activities, and
mandatory training and education;
(iii) Reasonable
Workload Tools or Agreed Principles and Guidelines
SECTION I: General
(a) The
Association and the Department agree that the workload calculation tool and
agreed principles and guidelines are a means to facilitate informed discussion
and decision making about reasonable workloads for nurses, rather than being an
end in itself.
(b) The
Association and the Department agree that one workload calculation tool is
presently not capable of meaningfully applying to every nursing context within
the public health system.
SECTION II: General Workload Calculation Tool
(a) The
Association and the Department have reached agreement on the name and key
characteristics of the interim general workload calculation tool for nursing to
be implemented in medical and surgical inpatient wards in acute public
hospitals. The interim general workload calculation tool will be known as the
general workload calculation tool.
(b) The general workload
calculation tool possesses the following key characteristics:
1. Value of the
nursing weight - In applying the general workload calculation tool, a nursing
weight of 1 is equal to 4.8 nursing hours per patient day (NHPPD).
2. Average
nursing intensity - For each ward or unit in which the tool is applied, the
average nursing intensity for that ward or unit is obtained by applying AN-DRGs
case mix data for all patients in the ward, viz, the data is to be
comprehensive, validated, and for a uniform period. The AN-DRG Version 4.1
Nursing Service Weights are applied.
3. Occupancy
rate - The application of average annual occupancy rates in the general
workload calculation tool is:
for wards/units with occupancy rates 85% and over - a
rate of 100% applies;
for wards/units with occupancy rates between 75% and
84.9% - a rate of 85% applies; and
for wards/units with an occupancy rate below 75% - the
actual occupancy rate applies.
The occupancy rate is the percentage count of the
number of inpatients accommodated at around midnight each day, as recorded in
the 'Daily Record Book' (or its computerised equivalent), divided by available
beds, on an annualised basis.
4. Available
beds - The average number of available beds is calculated, to account for
changes in this figure during the course of a year.
5. Length of
shifts - The length of shifts reflects those rostered to be worked in the ward
or unit.
6. Minimum
staffing levels - Use of the general workload calculation tool does not
displace present minimum staffing requirements to ensure safe systems of work
and patient safety.
7. Coverage -
The general workload calculation tool is applied to calculate staffing levels
for those nursing staff providing direct clinical care. It is not applied to
positions such as Nursing Unit Manager, Clinical Nurse Educator, Clinical Nurse
Consultant, dedicated administrative support staff and wards persons.
8. Application
and monitoring - the general workload calculation tool will be applied to the
ward or unit on an annual basis, and with the ability for the Nursing Unit
Manager to monitor monthly.
9. Relief for
Annual leave - The annual leave `relief' factored into the tool reflects the
annual leave entitlements under this Award for the employees arising from their
actual shift patterns. However, this figure may be adjusted when applying the
tool at ward level for planned periods of low activity or annual ward closures
that mean less leave relief is required.
If circumstances arise whereby the planned periods of
low activity or annual ward closures do not take place, the general workload
calculation tool should be applied again in light of those altered
circumstances and staff deployment.
10. Relief for
Sick Leave, FACS Leave and Mandatory Education - To account for these factors,
a figure of two weeks (equating to 76.0 hours based on a 38 hour week) per
annum is factored into the general workload calculation tool. This figure is
subject to joint review by the Association and the Department, on request by
either party.
11. Other factors
- In agreeing that the tool is a means of facilitating informed discussion and
decision making about nursing workloads, there are a range of other factors to
consider. These factors include but need not be limited to patient type (for
example, high dependency patients, day only patients, patients requiring close
observation, patients awaiting nursing home placement); the available level of
support staff (ward clerks, lifting teams etc); teaching and research
activities; provision of nurse escorts; emergency presentations in smaller
facilities; and ward geography.
Staffing of wards/units will be planned using 1 = 4.8
NHPPD as the value of the nursing weight. It is recognised that application of
this value will be subject to variation to account for these other factors or
over shorter periods of time. If there is continued variation from this value
in practice, the issue will be considered by the relevant reasonable workload
committee.
12. Exclusions -
the general workload calculation tool is not to be applied to:
intensive care units;
high dependency units;
specialty designated coronary care units;
specialist burns units;
emergency departments;
operating theatres;
midwifery services;
intensive care mental health units;
mental health admitted patient units
community nursing;
community mental health nursing; and
Multi-Purpose Services.
(c) The
Association and the Department agree that the name and key characteristics of
the general workload calculation tool may be amended by agreement from time to
time, and the Award will be varied to reflect the amendment.
SECTION III: Australian Confederation of Operating Room
Nurses (ACORN)
(a) The
Association and the Department agree that in the interim the ACORN 2002
standards will be implemented in operating rooms. The parties agree that
because these standards have been established and used for a number of years,
the key characteristics are not included in this Award.
SECTION IV: Birthrate Plus
(a) Birthrate Plus
is a framework for workforce planning and strategic decision making and has
been in extensive use in UK maternity units.
(b) A project has
commenced to adapt and modify Birthrate Plus to reflect the NSW Health
environment. The first phase of the project is designed to field test the data
collection tool for validity and reliability in the NSW setting, leading to
adaptation and subsequent adjustment of the workforce calculations. Once this
is done, it is planned to investigate State-wide implementation. The
Association and the Department will participate in this project and continue to
monitor progress to ensure timely introduction of a workload acuity calculation
tool based on Birthrate Plus.
SECTION V: Inpatient Mental Health Principles &
Guidelines
(a) The
Association and the Department have agreed that the following principles and
guidelines will apply from 26 June 2007 in all inpatient mental health units
and be used by managers in the evaluation of nursing staff levels and for the
Reasonable Workload Committees to assess and manage identified workloads
issues.
(b) Inpatient
mental health units include but are not limited to:
Acute Adult;
Closed / Open Units;
Forensic Units;
Child & Adolescent Units;
Older Adult;
Co-located Units;
Stand alone Units;
Psychiatric Emergency Care Centres (PECC);
Rehabilitation;
Extended Care Units.
(c) When
determining the nursing productive FTE the following should be considered:
1. The previous
12 months activity should be used as a guide unless the unit has had a
significant change in activity, presentation number or type, or where a new
model of care has commenced which has impacted on the type of presentation or
length of stay;
2. Staff
assessment will be based on comparisons to the FTE utilised in the individual
unit in the previous year, using the monitoring reports, in conjunction with
professional judgement and information on known workload issues;
3. Categories
The number of inpatients requiring 1 staff or more to 1
patient
The number of inpatients requiring close observation
The number of inpatients requiring sighting at regular
intervals
The number of inpatients nearer to going home;
4. Level &
frequency of aggressive behaviour displayed by patients and based on clinical
risk assessment;
5. Level of
suicidal behaviour displayed by patients (see MH-OAT risk level);
6. Level of
vulnerability / potential of exploitation from others (such as sexual safety,
financial exploitation);
7. Age of
patient and co-morbidities;
8. Patients with
a dual diagnosis;
9. Type of facility
and unit;
10. Design of
unit;
11. Number of beds
available;
12. Local factors
referred to in Paragraph (a) of subclause (ii) Reasonable Workload Principles
may include but are not limited to:
(i) The available
level of support staff (eg ward clerks, medical officers, patient support
officers, allied health staff)
(ii) Teaching and
research activities
(iii) Provision of
nurse escorts
(iv) Ward geography.
(v) Data
entry/documentation including M H-OAT.
(d) When
determining the nursing non-productive FTE required:
1. No less than
six weeks (30 days) annual leave relief per productive FTE for staff working
shift work and no less than 4 weeks (20 days) for non-shift workers must be
included.
2. No less than
two weeks (10 days) of sick/FACS leave and mandatory education relief per
productive FTE must be included.
3. Replacement
for long service leave and paid maternity leave should not be considered part
of the funded FTE unless additional FTE is set aside for this purpose.
Traditionally funding for this replacement is managed at a central cost centre
for a facility or service (this must be determined prior to finalising
established FTE).
4. Assess impact
on staff for workers' compensation / return to work programs on the FTE
required.
(e) General
1. Nursing Unit
Managers, Clinical Nurse Educators, Clinical Nurse Consultants and Nurse
Practitioners do not carry a direct clinical load.
2. Consideration
should be given to the evolution of future clinical roles in nursing.
3. Consideration
should be given to the additional responsibilities related to other activities
such as the Magistrates Hearing and the Mental Health Review Tribunal and
associated escorts.
4. Consideration
should be given to the impact of future legislative requirements on workloads
where reasonably known.
SECTION VI: Community Health Principles & Guidelines
(a) The
Association and the Department have agreed that the following principles and
guidelines will apply from 26 June 2007 in all Community Health Services and be
used by managers in the evaluation of nursing staff levels and for the
Reasonable Workload Committees to assess and manage identified workloads
issues.
(b) The current
agreed average 'face-to-face' ratio in the Community Health Service (CHS) shall
be used as the starting point for consideration of staffing levels where
indications are that staffing numbers are insufficient to manage the workload.
(c) Funded /
budgeted FTE must include no less than 4 weeks (20 days) of annual leave relief
per productive FTE. Where staff are required to work shift work or weekends
then no less than 6 weeks (30 days) should be included. Managers are
responsible for scheduling annual leave equitably throughout the year to manage
leave liabilities and to prevent unreasonable increased workload for remaining
employees arising from the taking of leave.
(d) Funded /
budgeted FTE must include no less than 2 weeks (10 days) of sick / FACs leave
relief and mandatory education relief per productive FTE. Cost centres with
child and family services must include an additional day to accommodate
mandatory education leave for child protection.
Funded FTE available for relief of sick / FACS /
mandatory education is to be utilised as required when this leave is taken
rather than used for permanent employment.
(e) Replacement
for long service leave and paid maternity leave should not be considered part
of the funded FTE unless additional FTE is set aside for this purpose.
Traditionally funding for this replacement is managed at a central cost centre
for a facility or service.
(f) Assess impact
on staff for workers' compensation / return to work programs on the FTE
required.
(g) Existing
appointed positions, eg. CNCs and managers, must be maintained in their current
role, and except in the case of emergencies, shall not be routinely used to
cover nursing shortages in the general workload areas.
To ensure this occurs, each appointed position should
have a position description that defines the scope and requirements of their
primary role.
Leave relief for these positions is required in the
funded FTE.
(h) Induction
programs including preceptorship should be in place to adequately supervise new
staff. These programs would include a reasonable number of
"supernumerary" hours followed by appropriate allocation of patients
according to the complexity of need and the new staff's level of training. The
ability to consult senior staff by phone should be ensured, particularly during
induction.
Funded FTE should incorporate a reasonable number of
additional Hours for this purpose based on historical turnover rates.
(i) Community
Health Services must have the ability to maintain a "pool" of casual
staff to manage unplanned leave and vacancies or a sudden and unanticipated
increase in workload.
(j) Reasonable
deployment within individual Community Health Services to address uneven
workload distribution should occur as a day-to-day management strategy. However
this should not be seen as a method of covering unfilled vacancies or ongoing
sick leave.
Long term demographic trends may result in adjustment
of boundaries to enable existing staffing to better accommodate the needs of
the community while still maintaining composition of their team.
(k) Appropriate
hours for case management should be included in the Funded FTE to maintain a
safe and holistic level of care for patients. This principle is inherent in the
needs for patients in the community.
(l) Appropriate
time for travel in the context of the local geography and traffic conditions
must be factored into hours required for clinical workload.
(m) In accordance
with occupational health and safety principles, hazards must be eliminated or
controlled, appropriate loading facilities must be provided, to enable
restocking of clinical supplies and equipment.
(n) Nursing hours
utilised in carrying out non clinically related activities eg. servicing of
vehicles should be monitored, quantified and incorporated into the FTE required
for a given service CHS.
(o) This list
indicates minimum requirements only and will be reviewed 12 months post
implementation by the Nursing Workload State-wide Steering Committee after
consultation with community health managers and clinicians.
SECTION VII: Emergency Departments
(a) The
Association and the Department have agreed that the following principles and
guidelines will apply from 26 June 2007 in Emergency Departments and be used by
managers in the evaluation of nursing staff levels and for the Reasonable
Workload Committees to assess and manage identified workloads issues.
(b) When
determining the nursing productive FTE required:
1. The previous
12 months activity should be used unless the ED has had a significant change in
activity, presentation number or type, or where a new model of care has
commenced which has impacted on the type of presentation or Length of Stay.
2. Staff
assessment will be based on comparisons to the FTE Utilised in the individual
ED in the previous year in conjunction with professional judgement,
incorporating anecdotal information on known workload issues.
3. Consideration
needs to be given to local factors affecting workload. This may have the
potential to increase the required FTE over and above that indicated by
activity.
(c) When
determining the nursing non-productive FTE required:
1. No less than
six weeks (30 days) annual leave relief per productive FTE for staff working
shift work and no less than 4 weeks (20 days) for non-shift workers must be
included.
2. No less than
two weeks (10 days) of sick/FACS leave and mandatory education relief per
productive FTE must be included.
3. Replacement
for long service leave and paid maternity leave should not be considered part
of the required FTE. Traditionally funding for this replacement is managed at a
central cost centre for a facility or service.
4. Assess the
impact on staff for workers' compensation / return to work programs on FTE
required.
(d) General
1. All level 5
and 6 Emergency Departments to have a dedicated shift coordinator on all shifts
in addition to the FTE required for clinical activity. The requirement for
additional FTE for the Shift Coordinator in Levels 1 to 4 Emergency Departments is at the discretion of
the facility after due consideration of the historical and anticipated activity
for each shift of the week
2. There is to
be an identified triage nurse on every shift.
3. Provision
must be made for the coverage of community retrievals and participation in the
facility Cardiac Arrest Team. This should be based on recent historical
activity.
4. Where an Emergency Department has a dedicated Psychiatric
Emergency Care (PEC) Unit, mental health specialist nurses must staff it. The
FTE required for appropriate coverage of the PEC Unit is in addition to the
requirement for the main sections of the Emergency Department.
5. The facility
must have a contingency plan to backfill nurses in the event that they are
called out as part of a disaster team.
6. This list
indicates minimum requirements only and will be reviewed 12 months post
implementation by the Nursing Workload State-wide Steering Committee after
consultation with Emergency Department and clinicians.
(iv) Role of
reasonable workload committees
(a) Reasonable
workload committees shall be established to facilitate consultation on
reasonable workloads for nurses, together with the provision of advice and
recommendations to management. Aspects of reasonable workload may include, but
need not be limited to, nursing workloads generally, the provision of
specialist advice, training, and planning for bed or ward closures or openings
as they relate to nursing workloads. It is intended that the committees, by
their operation, will make a positive contribution to the workload of nurses.
Reasonable Workload Committees are a mechanism to provide for informed
discussions at the local level and encourage the resolution where possible of
any workload disputes at this level in the first instance.
(b) The committees
by their operation shall not alter the rights and obligations of management to
decide nursing workload matters.
(c) Public hospitals,
mental health facilities and multi purpose sites shall monitor the
implementation of reasonable workloads for nurses using the agreed Monitoring
System in all inpatient wards/units.
Monthly and annual reports generated by the Monitoring
System shall be provided to the Reasonable Workload Committee to ensure the
committees have the information they need to assess workload issues.
In areas where the NSW Health Department and the
Association have agreed that the Monitoring System cannot apply, relevant
available data pertaining to workloads will be collected and collated for the
use of reasonable workload committees.
(d) It is intended
that the reasonable workload committees provide a structured and transparent
forum for all nurses to be genuinely consulted about workload matters through
an appropriate mechanism; contribute to the decision making process; and have
the ability to resolve disputes about workloads, should they arise, through the
committee process and provisions in this Award.
(v) Structure of
reasonable workload committees
(a) Upon request
by the Association, nurse(s) employed in a public hospital, or health service
or the employer, a reasonable workload committee shall be established for the
relevant public hospital or health service. Such requests shall be made to the
Chief Executive Officer of the Health Service. Where circumstances warrant and
are conducive to the efficient delivery of services, a reasonable workload
committee may be established by agreement between the Association and the
employer that covers more than one public hospital or health service.
(b) Upon request
by the Association or an employer a reasonable workload committee shall also be
established for the relevant Area Health Service or Statutory Health
Corporation.
(c) Each
reasonable workload committee shall comprise equal representation of employees
and the employer. Employee representation shall be determined by the
Association. Employer representation shall be determined by the employer as
appropriate. Committee size will be determined by agreement between the
Association and the employer. Every endeavour shall be made to minimise the
size of the workload committee, with provision to co-opt additional assistance
that may be required on an `as needs' basis.
(d) The committees
shall meet with a frequency determined by each committee, having regard to
issues and information to hand.
(e) The committee
members and the parties they represent shall make every endeavour to reduce or
eliminate any duplication of subject matter and coverage with pre-existing
structures and consultative mechanisms. Every effort shall also be taken to
ensure the most efficient meeting arrangements are instituted for operation of
the committees and to minimise disruption to nurses' rosters. The committee
members and the parties they represent shall make every endeavour to ensure
that any additional time and information imposts arising from the operations of
the committee are minimised.
(f) To enable
members of reasonable workload committees to discharge the committee's role and
carry out their responsibilities, attendance at committee meetings and
reasonable preparation time shall be deemed to be time on duty and remunerated
accordingly. Wherever possible, this time shall occur during the ordinary hours
of work.
(vi) Grievances in
relation to workload
(a) Notwithstanding
the provisions specified in sub-clauses (ii) to (iii) of Clause 48 - Disputes
in this Award, the following procedure will apply to resolve workload
grievances or staffing grievances directly arising from nursing workload
issues.
(b) A grievance in
relation to such matter shall first be raised at the local ward/unit level with
the Nursing Unit Manager responsible (or the appropriate manager).
(c) If the matter
remains unresolved, it should be referred to the appropriate Nurse Manager,
Director of Nursing or Area Director of Nursing, depending on the nursing
executive structure of the public hospital, health service or public health
organisation in which the grievance has arisen.
(d) If the matter
remains unresolved, it should be referred to the appropriate public
hospital/health service/public health organisation reasonable workload
committee for consideration and recommendation to management. If the matter
cannot be resolved by this committee, the issue may be referred an Area Health
Service or Statutory Health Corporation committee under subclause (v) (b).
(e) If the matter
remains unresolved, it should be dealt with in accordance with the provisions
of sub-clauses (iv) to (ix) of Clause 48 - Disputes in this Award.
2. The variation
shall take effect from 18 December 2007.
J.
McLEAY, Commissioner
____________________
Printed by
the authority of the Industrial Registrar.