a slight skewed observation to the conversation, but I once knew a num who told her staff on the early discharge program that they only needed 15 minutes per woman per visit. Therefore they could come back and take a patient load in the unit as well.
Impossible to measure how much time is needed when being with women. In fact, I often find the mistakes i make with documentation or time management occur when I have spent much time talking, listening, debriefing and just being with them. I've literally forgotten the paperwork in lieu of what I believe is a higher priority. Unfortunately the hospital system does not recognise this input in their DRG's, and does not value this input enough to support midwives who do this. Robin. ----- Original Message ----- From: "Sandra J. Eales" <[EMAIL PROTECTED]> To: <[EMAIL PROTECTED]> Sent: Monday, April 07, 2003 11:12 AM Subject: [ozmidwifery] Workloads - doing something about it > Nurses and their unions have been struggling with tools for workload > management for a long time. The ratios in Victoria look promising as you > say but I imagine there will still be inherent problems as Marilyn mentioned > the complexity needs to be taken into account. but more than the medical > complexity. Two women with the same DRG may require quite different levels > of midwifery time. Medically they may be judged uncomplicated because they > had a spontaneous vaginal birth but one will breeze through it and the next > will be very traumatised and need much more support to recover emotionally > and physically to be able make the transition to motherhood, breastfeeding, > parentcraft. > > The problem comes down to articulating and measuring the value of nursing or > midwifery work > The most valuable part of caring for a woman is the "being with" her - > talking her thru the hard parts and coaching her to relax, rubbing her back > or showing the partner what to do in, supporting her physically and > emotionally. This isn't properly measured though - For most tools that try > to measure workloads, jobs are broken down to tasks - doing observations, > giving medications. The value of the time that is used by a midwife in > "being with" a labouring woman or a vulnerable postnatal mum trying to > breastfeed, or the nurse who stops running for a moment to comfort the sick > or dying by just being with them. > Nurses and midwives don't articulate the value of this part of our job and > are as likely to criticise those who do. > The clients appreciate it and know that this is one of the most important > elements of our job but where is it expressed in terms of workload > justification. > Deep within us when know we have done a good job and have job satisfaction > only when we have this time to be with our clients. Too often nurses and > midwives spend their whole work day racing frantically from one task to the > next without making the deeper connection required for caring and healing. > We are the only ones who can make this time available. We need to recognise > the value of caring and demand the time to do it properly. > > > Sandra > > > ----- Original Message ----- > From: "Heartlogic" <[EMAIL PROTECTED]> > To: <[EMAIL PROTECTED]> > Sent: Sunday, April 06, 2003 3:49 PM > Subject: RE: [ozmidwifery] Bullying - doing something about it > > > > Hmmm, you Barb and Sandra are amazing. Both being active in the union and > > doing what needs to be done! How sensible. I had drifted away from the > > union idea and hadn't been a member for ages, thinking that the union > didn't > > have midwifery issues at heart and so was no longer relevant to me. It > > never occurred to me to become more active in the union, which would have > > been a far better plan I realise now. A position I now realise was the > > result of my version of learned helplessness, didn't think I could make a > > difference through that pathway. > > > > It has only been since coming in out of the wilderness (homebirth > practice) > > and seeing how it is for my colleagues and students, not to mention the > > director of nursing who had been sidelined so much from the role of > managing > > nursing (and midwifery)and who has been subjected to corporate bullying... > > grrrr... that I felt moved to do something strategically intelligent > instead > > of whinging and/or feeling aggrieved (which was VERY tempting and which I > am > > still seeking to avoid doing :-) > > > > The position of the Realnurses team on the many complex issues facing our > > twin professions also gives me real hope. We can make a difference. > > Interesting looking at Victorian facts and stats about ratios for > example - > > read on if you are interested... > > > > in solidarity ;-) > > > > Carolyn Hastie > > Council candidate, Realnurses and Midwives team (NSWNA Election June 03) > > www.realnurses.net > > > > I thought you would be interested in what is happening about ratios, so > have > > included the following information: > > > > The Realnurses team are committed to delivering mandatory, enforceable > nurse > > to patient ratios encompassing acuity and safe skill mix. > > > > This will be done in every sector - not just the public sector > > > > And this is only the start of our campaign to make nurses work easer, > safer > > and more enjoyable. > > > > The Real FACTS about ratios > > > > Fact: Ratios have seen 2650 nurses return to the public sector in > Victoria > > > > Fact: Victorian universities have seen a 26.5% increase in nursing > > enrolments since ratios were introduced > > > > Fact: Victorian employers argued that they would need between 800 and 1200 > > extra nurses, which they claimed would be impossible to get. In fact 2650 > > nurses returned > > > > Fact: In the Victorian ratios case the employer argued that they would > > need to close up to 1200 beds. They got the extra nurses despite the > global > > nursing shortage and the mass bed closures did not eventuate > > > > Fact: The majority of wards and units in Victoria have now met the ratio > > requirements while NSW struggles with a nursing shortage > > > > Fact: Ratios are now in use in City, Regional and Rural areas of > Victoria > > > > Fact: Ratios are being used successfully in a wide variety of clinical > > settings including medical, surgical, ED, midwifery, OT, ICUs, > > Rehabilitation, CCUs, Palliative Care and Special Care Nurseries > > > > Fact: Ratios in Victoria are minimum staffing levels. They also take > into > > account skill mix and acuity of patients. Agreements have been signed in > > some areas to give specific wards higher ratios > > > > Fact: As part of the ratios case in Victoria, nurses were awarded 3 days > > paid professional leave > > > > Fact: The Judges in the ratios case stated that ratios had to be met > > through the employment of permanent nursing staff > > > > Fact: The Judges ordered the employer to employ an additional 50 FTE > CNEs > > and an additional 50 FTE CNCs > > > > Fact: In Victoria ratios have improved roster planning > > > > Fact: Ratios are enforceable and guarantee nurses appropriate and safe > > staffing levels > > > > Fact: In Victoria, 'Patient Dependency Systems' were tried and discarded > > because they were not enforceable and management did not follow them > > > > Fact: Management in Victoria can no longer keep beds open on a promise > that > > they will find more nurses later in the shift > > > > Fact: The Victorian model of ratios has been such a huge success that > > models are being introduced in Queensland, Tasmania, Western Australia, > > California USA, Massachusetts USA, Maine USA and are being looked at in > New > > Zealand. > > > > > > ANF Victoria research is showing that ratios are responsible for: > > > > > > 1. Reduction in staff turnover > > > > 2. Reduction in sick leave > > > > 3. Improved morale > > > > 4. Increased graduate confidence because of suitably resourced > preceptors > > > > 5. A decline in workplace injuries > > > > These facts are from the ANF Victoria website www.anfvic.asn.au and from > the > > AIRC Victorian ratios decision. Please take the time to check the website > > and see for yourself. > > > > What About NSW > > > > Professor John Dwyer, Professor of Medicine, University of New South Wales > > and Clinical Director of programs for Medicine and Oncology, Prince of > Wales > > Hospital, said as part of his evidence in the 'Whats a Nurse Worth' case: > > > > 'Now I know the argument is if we specify the ratio, given the number of > > nurses we don't have, we would have to close a lot of beds but the > argument > > can be put the other way, until tested no one can give the answer'. > > > > The Realnurses Team say it is time to test the argument. > > > > He went on to say: > > > > 'We have heard in Victoria where ratios were introduced the (sic) prophets > > of doom who said that would mean a decrease in the number of beds you will > > be able to run have been found wanting. Nurses are voting with their feet > > and coming back into the system because of ratios. I believe for my sort > of > > hospital this would be a very important issue.' > > > > Why has NSW waited for so long for workload management? > > > > . The Realnurses team are committed to the introduction of nurse to > > patient ratios encompassing skill mix and acuity in all sectors > > > > . The Realnurses team are committed to ratios because they give > nurses > > mandatory enforceable staffing levels not just a daily dispute system > > > > . The Realnurses Team are committed to nurse to patient ratios > because > > dependency systems alone are not working > > > > > > > > -- > > This mailing list is sponsored by ACE Graphics. > > Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe. > > -- > This mailing list is sponsored by ACE Graphics. > Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe.
