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)

 

 

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.