Re: [ozmidwifery] Bullying - doing something about it
Dear Carolyn I like to fantasise that if we get one-on-one models of midwifery care, the women will flock to them and opt for homebirth as they are in NZ . Homebirth and indiviadualised care is where there is no concern for many of the things on your list. This change in demand for services would necessitate hospital managements having to tidy up their management of these problem areas or not have enough midwives nor women opting for this!!Denise H - Original Message - From: Heartlogic To: [EMAIL PROTECTED] Sent: Saturday, April 05, 2003 4:49 AM Subject: RE: [ozmidwifery] Bullying - doing something about it Judy wrote: With regard to the workload, I have just found out that the position I left last december has not been filled and more FTE have been cut from the staffing. Antenatal education is suffering and the workload is the same. I really don't know how the management (not midwife friendly) expects quality care. These hospital philosophies mean nothing when they keep doing this. Forcing such workloads is bullying in itself but I am sure they would not recognise this. Judy Yes, it is bullying Judy and no, they don't recognise it for what it is - because 'they' are so divorced from being 'with people' (aka with woman) - 'they'haven't got a clue as to the reality of our work - and so we have to tell them that the way 'they' construct our work environment is abusive. The CEO ofour place is a doctor whose background is pathology.The general manager is a financial whizz who is also adoctor and one who has never, from what I understand, practised bedside or even officechair side medicine. These people have absolutely no idea of what either midwifery or nursing is about. They do not understand the practice of either discipline at all. It is impossible for them. People can't do what they don't know. I personally find it simply amazing that these people have the right to dictate how nursing and midwifery budgets are spent. Where are all the tough characters that ruled the budgets for our professions andhad a say in the executives of the Health Services? The current trend towards clinical streaming is leading more and more away from the notion of self determination with financial matters. This is a huge issue for the union(s) to take up. Great opportunity here for all of us to unite and give the same message in a format 'they' understand. Time to stand up and be counted - we have the numbers and the power. I have been thinking - what would happen if we said by such a such a day at such and such a time, all over Australia, midwives and nurses would walk out and everyone did. We could give them two weeks notice, get doctors and adminstrators to organise themselves into rosters to provide care and then every single one of us, walk out. We have been 'nice'and compliant for too long. It is like being in a domestic violence situation - everyone wonders why women don't leave abusive men, but we know don't we? We care too much. Imagine if we asked for: midwifery models of care one to one care for labouring women well babies to be counted in workloads one midwifeto four motherbaby pairratios in prenatal/postnatal wards (that is whether the baby is internal or external to the mother) a recognition of the vital importance of the mother/baby relationship and the need to factor this in to workload considerations, especially for women with social challenges midwifery budgets managed by midwifery managers senior midwife midwifery directors who had equal standing on health service executives career pathways for midwives no HEC's on midwifery courses Mentoring for managers mandatory study leave for professional development clinical midwifery educators on each shift in every unit indemnity insurance for privately practising midwives 24 hour child care onsite flexible rosters mandatory safe skill mix anything else? and that's just midwifery,nursing needs have parallels Imagine. How long do you think we would be out for??? In solidarity ; -) gives me goosebumps just thinking of the possibilities When desire is greater than fear, we can achieve anything. Martin Luther King and Gandhi showed us that passion fora just cause and commitment makes social change inevitable. Carolyn Hastie council nominee for the Realnurses and Midwives team (NSWNA election June 03)
RE: [ozmidwifery] Bullying - doing something about it
Unfortunately AIRC gave us (Public sector) the Business Planning Framework as part of the interim or MX award not ratios. It is complex to describe but it seems to be working at Townsville Hospital. If you get onto their home page and look up the Red File it has the rostering project which uses the BPF. Townsville seems to be able to close beds depending on staffing levels. It amazes me. Qld members, would you believe that those first educated (L3,4,5) on the BPF had been using the abridged version leaving out getting service profiles and consultation process. How, one must ask. Please check with your delegates that the full version is used in training. We wait patiently for the final Commission decision. Homebirth midwives do have it tough but so too the hospital midwives. There have been many negative changes imposed onto midwives that have impacted on being able to provide midwifery care as it should be! Cheers Barb -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] Bullying - doing something about it
Barb Congratulations on your election to council. Good to have a practicing midwife on it. I'm sure you'll do a good job. Catch up with you at conference Sandra - Original Message - From: B G [EMAIL PROTECTED] To: [EMAIL PROTECTED] Sent: Sunday, April 06, 2003 10:00 AM Subject: RE: [ozmidwifery] Bullying - doing something about it Sandra, What you have written is so true. People like to 'leave it to someone else' or 'I'm too busy' yet are so critical when things don't pan out the way they wish. I also feel some of that behaviour is indicative of repressed groups. Bullying behaviours are so rampant in health many people fail to see it as this, they think it is normal behaviour. Keep up your union activities up north Sandra. Good to see the media is picking up and reporting maternity service concerns. Cheers Barb -- 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.
Re: [ozmidwifery] Workloads - doing something about it
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... g... 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
[ozmidwifery] shoulder dystocia??
Dear Denise, In response to your questions on the 19th March - I have been pondering, and hoping someone else would start the discussion - I find the whole area of classifying degrees of shoulder dystocia very hazy. It is very subjective, and the skill and experience of the midwife makes a big difference. I think there is a reluctance to classify mild shoulder dystocia as dystocia at all - because of the potential negative impact that this might have on future births - ie elective CS. I think the moderate - severe shoulder dystocias are easier tolabel - because there is invariably somecompromise or injury to the baby, which kind of"justifies" thelabel, and any management of future births. I guess I also use the condition of the baby as a guide - if I am caring for a woman whose previous birth notes say she had a moderate shoulder dystocia, but the baby had good Apgars, etc, I'd be inclined to believe that it was only mild. I don't know of any specific definitions or boundaries to classify degrees of dystocia. Jacky
Re: [ozmidwifery] Workloads - doing something about it
Sandra wrote: "The problem comes down to articulating and measuring the value of nursing ormidwifery work The most valuable part of caring for a woman is the "being with" her -" The way that women value the midwifery care is with observations like "The "nurse"was short and sharp with me; no one seem to have any time to help me; There were so many people telling me different things;..the "nurse" was really kind to me, she was lovely." A pity that these observations aren't quantifiable in midwifery ( nursing) yet in customer service industries this is what it is all about. Maybe we should look at our profession as a customer service focussed industry and market ourselves that way? But then, that is what private practice midwifery is all about, otherwisethe customer doesn't pay us.It certainly sharpens our focuss then! I don'tenvy anyone working in the hospital system. Give me case loading, one on one in the community anytime thanks. MM
Re: [ozmidwifery] Workloads - doing something about it
Not skewed at all Robin. This is exactly what I'm talking about. This is the situation we need to be fighting about and not simply accepting the management determination of what our job is and how long it takes. 15 minutes would be just for the paperwork, then there are physical checks of mother and baby, assistance, demonstration, discussion of breastfeeding, infant behaviour and other parenting education, to say nothing of the emotional psychological assessment, support and reassurance. We do need to make a habit of articulating what we do - for ourselves and others to understand the value of what we do. Midwives and nurses need to stop:- 1)doing antenatal classes and the preparation for them in their own time (as is I was told last week at the local ACMI subbranch meeting is happening in a neighbouring hospital in this region and many others I suspect) 2)skipping meal breaks to fit the jobs in 3)doing unpaid overtime as they catch up on that paperwork that didn't get done because they were debriefing someone who had been through a traumatic event 4)accepting the unacceptable We need to argue with superiors and managers who consistently underestimate our workloads and undervalue us. We need to be assertive and less accepting of the restrictions placed on us. Nothing less than a revolution will do. I'm starting to foam at the mouth now so I'll stop...for a while anyway. Sandra - Original Message - From: Robin Moon [EMAIL PROTECTED] To: [EMAIL PROTECTED] Sent: Monday, April 07, 2003 12:27 PM Subject: Re: [ozmidwifery] Workloads - doing something about it 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.
