2010-2011 QNU State Budget Submission

Published: 8 February 2010

Summary of Recommendations

Workforce Planning
  • Develop a comprehensive nursing and midwifery workforce plan;
  • Increase the VET sector diploma and certificate course numbers;
  • Address the existing disincentive with respect to VET sector courses being up front full fee paying courses (as opposed to HECS/PELS scheme in tertiary sector);
  • Undertake an urgent review of housing needs of current and future public sector employees who will provide government services in areas of high economic growth or significance and initiate programs to provide affordable housing for these workers. This will require a whole of government approach to ensure a range of adequate facilities are available;
  • Provide adequate housing for public sector employees in growth areas throughout the state.
Recruitment and Retention
  • Provide appropriate support to all new graduates including one week’s additional supernumerary support from an experienced registered nurse (to date this has not been implemented across the state in a consistent way) and properly funded preceptorship schemes to support the transition of new graduates to the workforce;
  • Review the proxy amount allocated to Health Service Districts for new graduate support that currently stands at $1600. This amount has not been reviewed for many years;
  • Provide adequate financial support for all new graduates and centrally fund employment of new graduates to remove the budget disincentive at Health Service District level;
  • Conduct adequate numbers of refresher and re-entry program for nurses;
  • Create new nursing positions at the Health Service District level to provide support to new nursing employees and those re-entering the nursing workforce and help orientate and retain nurses in the Queensland Health workforce (Nursing Support Officers);
  • Develop, implement and evaluate a sustainable and robust recruitment and retention strategy for nurses and midwives which enhances both patient and staff outcomes;
  • Maintain a pipeline of student nurses within Queensland Health facilities through the provision of additional clinical placements in the facilities/services and the required clinical support;
  • Liaise immediately with federal government regarding increasing nursing university places and clinical placements;
  • establish a dedicated funding stream for clinical placements for undergraduate and postgraduate students;
  • Employ undergraduate nursing students and students in the VET sector as another potential “pipeline” for future Queensland Health nurses;
  • Investigate a strategy for school based ‘apprenticeships’ in nursing in conjunction with the VET sector;
  • Provide scholarships for disadvantaged groups (e.g. ATSI, NESB and unemployed) to obtain VET qualification in nursing;
  • Implement targeted health sector specific Workplace English Language and Literacy (WELL) courses for nurses (and other health workers) from Non-English Speaking backgrounds;
  • Provide cultural awareness training and support for overseas trained nurses and other health professionals;
  • Provide central funding to ensure all Queensland Health staff have the opportunity to access the Joanna Briggs Institute (JBI) resources.
NAMIG Projects
  • Establish an ongoing mechanism for appropriate application of the BPF-NR V4 across Queensland Health;
  • Continue to engage Queensland Health non-nursing personnel and other key decision makers in the implementation of the BPF-NR V4 including mechanisms to resolve disputes between nursing and finance personnel promptly;
  • Establish processes and resources to support the NUM role to facilitate appropriate implementation for BPF V4;
  • Establish mechanisms to resolve disputes around workload issues at the NCF and specialist workload panel levels timely and effectively, including mechanisms to record and share agreed strategies developed to address workload concerns;
  • Establish mechanisms to identify, monitor and address deficiencies identified in BPF-NR V4 training;
  • Create a nursing position in each Health Service District designated as BPF-NR expert (one to provide ongoing support to nurses on the implementation of the BPF-NR.
  • Implement and evaluate the nursing and midwifery models developed within the NAMIG project;
  • Implement fully the relevant recommendations contained in the Hirst Rebirthing (2005) report (i.e. those relating to midwives and models of midwifery care);
  • Develop and implement mental health nursing models in specialty areas such as Mental Health and Emergency Departments. These models need to include in their core staffing profile a Nurse Practitioner, Clinical Nurse Consultant and an increase in the number of clinical nurse positions;
  • In partnership with Universities, develop a strategy to fast-track the Masters Level qualification required for Nurse Practitioners by recognizing prior learning and streamlining courses to meet Queensland Health’s need for extended nursing and midwifery roles commencing with the Rural and Isolated Practice Registered Nurse (RIPRN);
  • Implement nursing career structures including Nurse Practitioner and Advanced Practice Enrolled Nurse initiatives;
  • Create at least 40 additional Nurse Practitioner scholarships;
  • Support nurse in gaining Nurse Practitioner endorsement through appointment of Nurse Practitioner candidate positions;
  • Set up a project to develop and implement nurse sensitive indicators within Queensland Health (linked to the Queensland Health reporting framework and also the Queensland Health Safety and Quality Agenda). This would be an essential adjunct to the work that will be done through NAMIG to develop new nursing and midwifery models;
  • Form multi-disciplinary teams to provide post acute care and case management for key chronic illness areas;
  • Extend the Darling Downs LINCS (Linking Chronic Disease Services) program into other areas;
  • Initiate protocols to drive patient care throughout the care continuum that ensure that appropriate resources and care providers are available in a timely fashion;
  • Provide the infrastructure and resources necessary to implementing protocol initiated discharge including education and training;
  • Develop and implement a protocol initiated discharge policy across following an appropriate trial;
  • Designate hospitals in the nursing home models and Nurse Practitioner services as nursing homes to prevent unnecessary hospitalisations. The skill mix in this area needs to improve to accommodate this move, hence the importance of the skill development strategy for aged care;
  • Achieve the Health Service District “targets” we suggested above;
  • Develop “step down” facilities wherever possible to shift those not requiring acute care to more appropriate care modalities;
  • Ensure that ACAT assessments are re-prioritised so that these clients awaiting assessment in hospitals are assessed as a priority;
  • Ensure appropriate application and communication of policies on nursing home preference list placement from hospitals. (Also ensure that clients are able to transfer to homes that are higher up the preference list as beds become available.)
  • Continue to support the advancement of appropriately configured multi-disciplinary models of care that span the health continuum;
  • Provide appropriate community based housing for those requiring long term care whist maintaining appropriate acute care services when clients need them;
  • Implement mechanisms to effectively quarantine funding within health for primary and preventative care;
  • Create Nurse Practitioner and midwifery models of care that facilitate coordination of care across acute and non-acute sectors;
  • Develop multi-disciplinary models of care in acute and non-acute sectors – e.g. determine optimum skill mix required in Emergency Departments depending on usual patient mix – not limited to medical and nursing personnel but includes, allied health (e.g. physiotherapy, social work, pharmacy personnel) as well as appropriate levels of administrative support;
  • Empower health personnel at the service delivery level to design and implement patient centred models of care – fund external independent evaluation of trials of new models;
  • Support the development of standardised protocols to inform health service delivery – e.g. protocol initiated progress through the health system including discharge.
Rural and Remote
  • Formalise a maternity services reference group to drive the ongoing implementation of appropriate midwifery models;
  • Develop and implement a midwifery recruitment and retention strategy in order to address areas of critical shortage of midwives across the state;
  • Provide case load midwifery models;
  • Build and retain a midwifery workforce particularly for the small rural facilities;
  • Enhance maternity service resources in rural areas. Many are very rundown or equipment is shared with other areas;
  • Provide state employed home birthing services;
  • Provide Capital works for current community services in rural areas where a number of services share cramped run down facilities;
  • Conduct a pilot project for a roving rural case load team of midwives for low risk indigenous community groups;
  • Review adequately the current rural maternity services and urgently upgrade as required;
  • Provide and maintain safe and secure Queensland Health facilities and accommodation that are of an appropriate standard and are properly maintained;
  • Establish a consistent service delivery framework for rural and remote communities e.g. consistent standards for models of care;
  • Establish a consistent approach to consultative frameworks to involve the community and staff in health service decision making processes;
  • Provide resources to encourage local community members to acquire recognised health qualifications that enable them to remain in their community and progress in their career – e.g. extension of the indigenous nursing strategy;
  • Promote and support alternative health service delivery models in rural and remote communities –e.g. support nursing and midwifery models of care;
  • Ensure there are adequate transfer policies in place for rural and remote patients;
  • Install water tanks and solar power for rural facilities.
Health Service Planning and Health Facility Design
  • Provide education in health service planning and healthcare facility design for nurses/midwives and other health workers through continuing professional education and resource development;
  • Provide scholarships and bursaries for short courses, postgraduate coursework and/ or training modules which are available in Queensland universities (e.g. Queensland University of Technology) and other Australian universities (e.g. University of Technology Sydney);
  • Develop resources such as guidelines, journals and/ or manuals;
  • Provide BPF – NR V4 training for health service planning staff and formally include the BPF – NR V4 in the Queensland Health planning process.
Workplace Health and Safety
  • Provide extensive rollout of reasonable adjustment capacity in the form of extra staffing, and technological assistance to ensure nurses who have a permanent impairment do not have to cease working as the workplace is unable to accommodate their needs;
  • Ensure that Queensland Health meets it health and safety obligations, including the funding for the provision of training to Workplace Health and Safety Representatives;
  • Undertake Workplace Health and safety projects relating to: cytotoxic drug preparation and administration, the feasibility of establishing Latex free hospital environments and the prevention of violence against nurses;
  • Incorporate best practice health and safety design principles in all new capital works and redevelopments within Queensland Health, with particular emphasis on the provision of ceiling hoists and tracking systems in patient care areas;
  • Provide appropriate duress systems to all workers operating in peoples’ homes and those doing call out arrangements, particularly where the nature of the work makes them isolated and vulnerable to violence or abuse;
  • Amend section 51 of Schedule 2 of the Weapons Act 1990 to read ‘ person must not physically possess a knife in a public place or a school, or a health facility unless the person has a reasonable excuse’;
  • Review all ‘high risk’ units to minimise the risk of violence towards nurses;
  • Provide funding to implement the recommendations from the review of The Park that includes QNU representation.
Equity
  • Establish projects to investigate the needs of nurses (and other Queensland Health employees) with a disability that are employed by Queensland Health and devise and implement strategies including reasonable adjustment options, to retain these workers in meaningful work within Queensland Health;
  • Develop and implement strategies to increase the number of indigenous nurses employed by Queensland Health. This should be done in a coordinated fashion and operate within the context of the objective of closing the gap in indigenous life expectancy;
  • Develop additional support processes for nurses and other health workers from non-English speaking backgrounds, including those recruited on temporary visas to be employed in Queensland Health;
  • Investigate the feasibility of establishing a state-wide child care brokerage service for nurses and other Queensland Health employees;
  • Establish a network of dedicated Employment Equity Officers across Queensland Health with at least one dedicated Officer in each Health Service District.

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