The main state-based issue at present is the Melbourne by-election – held by Labor for 104 years, there’s some determined campaigning by both Green and independent candidates (and, according to some reports, more than one candidate who’s one running as the other). The Liberal party aren’t bothering to run for the seat at all, despite their majority of only one-seat, and even though they fielded candidates at the last two elections. I will write about the Greens tomorrow; today was all about the RDNS community rally and walk out I mentioned yesterday.

Let me start by saying how really impressed I was by the turnout – some 200 nurses, from RDNS centres around metropolitan Melbourne, showed their strength, unity and commitment to a campaign that has stretched into its tenth month.

(photo courtesy of ANF, Vic. branch)

It’s being billed on in the media as a pay dispute – just like the general public campaign (and I am so tired of channel 10’s caption “Nursing a grudge” I can’t tell you – the only grudge being nursed is by the government regarding ratios). What nurses and midwives in Victoria have, are, and will continue to fight for is protecting the public, fair conditions, equitable pay, and safeguarding the system for the next generation of nurses and midwives.

I wrote yesterday about the essential role RDNS and community health nurses play in keeping the public health care system running – without adequately funded services in place patients will need more frequent acute admissions, will be sicker when they are admitted, will stay in hospital for longer, and will increase demand for residential facilities. It’s not hard to see how all of that costs more money than appropriately budgeting the preventative and sub-acute services these nurses provide.

As I wrote last month, nurses are more likely than almost any occupation to sustain career-ending injuries. We are without question the highest risk profession for physical workplace injury (the emotional and psychological strain of medical training, particularly for surgeons, is not only disgraceful but underreported, ignored within the profession, and a topic for another time). RDNS and community health nurses have risks those of us in facilities have some measure of safeguard against – there is often inadequate or in sufficient equipment; the environment is not designed for manual handling; nurses are very often on their own, with no backup if the client’s condition changes; and no security staff in the event the client or a family member becomes aggressive or substance-affected.

For the dedicated nurses who decide to pursue a career in this specialty, the rewards can be many, including a higher degree of autonomy than hospital-based practice, and the ability to develop sustained and deep therapeutic relationships with clients. I know from those of my patients with whom I’ve worked for several years that this continuity facilitates better understanding of the patients’ needs; greater comfort in disclosing important information; the development of professional relationships with clients that last far longer than hospital equivalents;  the freedom to ask questions or voice concerns; and a broader, deeper understanding of the patient’s life in context, instead of just the sliver health, illness and hospitalisation comprises.

This all means better patient outcomes, and interventions that are more likely to cohere with what the patient really values. But these aspects are hard to measure, and though they contribute to better allocation of resources and intervention, they’re not easily costed. And if we can’t put a price on it, it must not be important.

For all that there’s rhetoric that task-based nursing is old-fashioned and outdated, across the board nursing time is calculated on tasks. I don’t disagree that tasks are important – nobody will thank you for holding Mrs Brown’s hand instead of giving Mr White his medications, Ms Green her antibiotics, and leaving Miss Scarlet in the bathroom for an hour. But nurses and midwives need enough time to be able to provide all the dimensions of therapeutic care and, as in all the other sectors, this is being eroded in District and community nursing.

This means heavier workloads, poorer care, burn out, compassion fatigue, and higher staff turnover – and that costs more money. I intend writing an entry about the costs of poor staffing, and the seeming inability management has recognising the importance of retention instead of focusing on recruitment – it’s a profession-wide issue that continues to be under-addressed. For now, suffice it to say that one US study estimates that replacing a nurse costs institutions twice that nurses’ annual salary. Even if that’s not accurate for Australia, even if it’s a quarter of that estimate, that’s a whole lot of money being wasted that could be utilised on services, and on staff.

The theme of our campaigns has been Respect Our Work. It’s unfortunate that there are still people who need to be reminded that nurses’ and midwives’ work, integrity, commitment, and the invaluable work we do needs to be respected.

ANF (Vic. branch) Secretary Lisa Fitzpatrick addressed the audience, reminding them of the battle to date, the hearing yesterday at FairWork Australia that halted management‘s attempt to have District nurses vote on a unilateral Agreement, and about the next stage of the campaign.

Members unanimously voted to suspend the latest escalation in industrial action, as a good faith gesture – FWA has brought the Conciliation proceedings forward a week, to tomorrow. I hope this is negotiated soon, but if not – know that RDNS nurses are not alone. There are over 63,000 of us, and we know this isn’t their fight, it’s ours. The nurses (and midwives) united can never be defeated – we just need to last one day longer than our opponents.