Background – ‘acuity’?
‘Acuity’ is a portmanteau concept that describes (without specificity) both the overall population of a ward (or hospital as a whole), and the relative sickness of a patient, the amount of care they require, and how precarious their position is. If the ward is very acute then we have a larger than average number of sick patients who require high level, skilled care. For laypeople anyone in hospital is, by definition, sick; for staff ‘sick’ means something very different – it means that we have serious concerns about the patient’s potential to deteriorate, either because their disease is rapidly progress, or failing to respond to treatment, or their underlying pre-existing conditions (co-morbidities) are significant and/or worsening, or that the patient may not have the reserve to continue to fight. If I report to my supervisor that I’m concerned about a sick patient, what I mean is that I have a better than even concern that the patient will need urgent intervention over the next few days or even hours – anything from an urgent medical review when they drop their blood pressure, to a transfer to ICU (possibly via theatre) or even full resuscitation.
Defending the ratios: from 2001 – 2007
Nurses and midwives in Victoria care for more patients, at less cost, with shorter bed stays than at any other time. Although local and international research consistently demonstrates that lowering the number of patients nurses and midwives care for results in better outcomes (fewer preventable complications, fewer errors, faster detection of deterioration, a dramatic shortening of admission length, fewer ‘failure to rescue’ incidents) at lower cost, every single Victorian government since 2000 has tried to weaken or remove ratios from Victoria’s public hospital system.
We weren’t given ratios in 2000 by the then-government – after almost a decade of savage cuts under the Kennett government, Victoria’s public health care system was in crisis – in 1992 there were 83,276 nurses registered in Victoria; just seven years later that figure had dropped to 69,794. The most significant factor was workload – they became untenable, as nurses were having to care for more patients, with higher acuity.
As ANF entered negotiations in 2000 it quickly became obvious that there was no common ground between the parties, and after negotiations stalled the dispute was brought before the now-defunct Australian Industrial Relations Commission, in the person of Commissioner Wayne Blair. After hearing long and involved arguments from both sides, the Commissioner accepted the ANF position that nurses are integral to an effective health care system, that the Victorian health care system was critically understaffed and underfunded, that the large-scale and ongoing departure of nurses must be reversed, and he decided in favour of introducing the world’s first ratios in order to reverse the exodus and thus return the system to health.
Yet only a year later we had to return to the fray, fighting this time for funding to ensure the ratios could be implemented fully (for a contemporaneous account of the introduction and first defence of ratios, click here). And every single time since then Victorian public sector nurses and midwives have renegotiated our pay and conditions (under an Enterprise Bargaining Agreement, which lasts from three to four years) we have had to take industrial action to defend ratios – first in 2001, again in 2004, and most bitterly in 2007.
In 2007 changes in industrial relations law meant that government had the option of docking employees who took industrial action. Despite the this threat, the 2007 campaign was the most united and coherent I’d been involved in – campaign shirts were launched at the Delegates conference in July, where reps were briefed on the fight that lay ahead of us.
Along with thousands of other nurses, and in the face of (what was for me) unprecedented employer harassment, I closed beds on my ward – usually running at thirty-two patients, every nurse chose to close one bed. Normally, we would group those beds into one area, so only one nurse was financially affected, and so that (at least during the day) a nurse could go down to Emergency to help out, because patients don’t stop coming in just because there are no beds. However, ward and hospital management wouldn’t allow grouping of beds, and their efforts to intimidate staff into opening beds merely strengthened our resolve. I was working weekend night duty, responsible for three other nurses and twenty-eight patients, including seven for whom I was directly providing care, and I was docked every cent. The funds were eventually reimbursed to all docked nurses, when ANF won a case supporting the position that employers had discretion over docking. And once again, if accordance with the majority consensus among nurses and midwives working in the system is that ratios are more important than any other condition, we won by agreeing to lower pay increases in order to retain ratios.
I will forever remember the final meeting of the 2007 campaign – things had been so unrelentingly grim, and the pressure from management so unrelenting and intimidatory, that I was convinced ANF (Vic branch) Secretary Lisa Fitzpatrick would be recommending strike action – so much so that I had already approached my parents about borrowing money to cover my rent and other expenses. The turn out was so great that we abandoned our usual venue, Dallas Brooks Hall, for the larger capacity of Festival Hall. The first big union to defy the government in a post-WorkChoices world, the street to Festival Hall was lined with members and officials of other unions, cheering us on.
The atmosphere inside was electric, the venue was a sea of red, and the atmosphere was a heady combination of grim determination and tightly held excitement. When Lisa stepped on to the platform, some ten minutes late, the room was hushed – and after a greeting her first words were “I have an Agreement I’m happy to recommend.”
At the very last minute the Bracks government agreed to almost every claim, and ANF’s concessions were minimal and predominantly tokenistic. It was an overwhelming victory for the union and a testament to both the resolve of our members and the determination of our officials. The 2007 campaign was the most heated, prolonged and intimidatory I’d been involved in – though not on the scale of the 1986 Strike, it prepared the membership for the fight that we were to face four years later, under a very different government.