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description= A periodic blog on matters health, union, social justice, and the occasional random rant;
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ock of work and flying home another fortnight of solitude or if you recruited couples unrelieved intimate proximity quarantine leave would need to be paid take place in a physically separate space from quarantine residents and accommodation for staff on duty and require its own dedicated catering and cleaning workforce who also need accommodation and leave time to avoid any cross infection that doubles at least the number of staff needed in victoria hotel quarantine workers are screened every shift by an onsite doctor and covid tested by nurses these tests are prioritised so the results are most often available before the worker has finished their shift to replicate that speed so any transmission is detected and curbed before it spreads widely means an onsite or nearby pathology lab working around the clock the pathologists and supporting lab staff may not need to isolate but would still need to fly in and out because regional facilities don t have an abundance of people with that education and skill unutilised and they would also need a purpose built lab that allows them to treat the highly infectious samples without risking transmission i briefly mentioned earlier the need for a well staffed hospital able to provide icu level care that would be for anyone who develops severe covid but we would also need health care facilities for anyone who has an acute illness or a chronic condition requiring health care oversight even as we saw in the recent victorian case an acute asthma attack at present these needs are managed by two specialty hotels one for people who have tested negative but have health care requirements from assistance because of a physical disability to people requiring oxygen from preexisting cardiorespiratory disease and one for people who ve tested positive to sars cov 2 whether or not they have signs or symptoms anyone in the health hotel who returns a positive test is transferred with strict precautions to the hospital hotel for close monitoring i haven t been clinical during the pandemic but i worked in an infectious disease ward during the swine flu and bird flu pandemics as with covid 19 most of my patients were well with only a few or no symptoms but i ll never forget the speed with which one patient with h1n1 deteriorated i ve changed mai s identifying details to maintain her confidentiality a 27 year old business woman who had been visiting family mai had been afebrile when leaving china but admitted later that she had experienced some low level cold symptoms headache congestion and a sore throat for the last two or three days of her holiday but they were very mild and she dismissed them over the course of her flight to melbourne mai developed a runny nose and a cough and on screening at tullamarine had a low grade fever she was transferred from the airport and directly admitted to the ward bypassing the emergency department with a presumptive diagnosis of novel influenza a h1n1 which was confirmed when a nasopharyngeal swab was positive for the virus for the first two days of her admission mai was mostly bored rather than ill her temperature sat between 37 c and 37 6 her oxygen saturation was at or above 94 and she had no real difficulty breathing on the morning of her third day in hospital mai reported feeling hot and for the first time felt slightly short of breath during her shower and needed to sit down she still didn t have a fever and her vital signs blood pressure pulse respiratory rate and oxygen saturation were all consistent with her previous readings but i started monitoring them every two hours instead of every four and notified the infectious diseases team although her vital signs were still unremarkable at 10am they were all a little off pulse and respiratory rate a little higher oxygen saturation and blood pressure a little lower and she looked less well a review by her doctors about an hour later found new changes on auscultation listening to her lungs with a stethoscope during breathing and while tapping different fields and a portable chest x ray confirmed pneumonia i inserted a cannula took repeat bloods mai had already had blood taken for routine biochemistry at 6am as usual and began the intravenous fluids and broad spectrum antibiotics prescribed by her doctors the blood work revealed that mai s kidney function was deteriorating so i inserted a urinary catheter to monitor her output and rechecked her vital signs it was now 12 30 and mai s needed oxygen via a mask to keep her saturation above 90 her respiratory rate had risen from 22 at 10am to 40 breaths per minute and a lot of effort and her blood pressure was dropping while her pulse rate was rising mai was developing septicaemia and her increased rate and work of breathing weren t sustainable for long the icu consultant reviewing mai decided to admit her she was intubated on the ward and by 1 30pm she was in intensive care on a ventilator with intravenous medication helping to maintain her blood pressure and correct her ph i ve included this story to illustrate just how quickly some people can deteriorate and why high level health facilities are needed alongside any kind of quarantine centre my experience with mai who survived her admission and recovered her renal function made me concerned when the federal government decided to quarantine the first people returning to australia on christmas island as it s a four hour flight to the nearest major hospital while her trajectory was unusually rapid mai s case wasn t unique covid especially the more contagious variants requires a high level of vigilance so staff will need to rotate regularly frequently say a three week block of work 21 consecutive days on two weeks of quarantine and two weeks leave attracting people to spend 70 of their time in lock down won t be easy even if the work is well remunerated so we need to factor in ongoing recruitment costs advertising assessing applications interview hr processing training and orientation and retention strategies including robust mental health support programs to the budget those are just some of the off the top of my head issues with a fifo quarantine model it s not impossible and it may be necessary but it would be hugely more expensive in every respect including environmental and take a substantial toll on workers creating a whole new quarantine system will not only be vastly more expensive but also have its own flaws and hiccups that won t all be evident until it rolls out in comparison the current system though absolutely imperfect avoids most of the issues i ve identified instead of scrapping it we would be better to address the problems that have been identified with it there are two that contributed to last week s cases ventilatory systems that aren t hospital quality and the use of surgical masks that aren t as effective as more expensive less comfortable high filter masks in response to the transmission victoria s quarantine hotels have rolled out the use of n95 masks for all staff at all times they re onsite except for breaks which are staggered and monitored which will substantially reduce the risk of another air borne transmission from a quarantined resident to a staff member and their infection control protocols are continuously reviewed to identify areas for improved practice it remains to be seen if this measure will be enough or if ventilatory systems need to be upgraded in quarantine hotels as well testing of existing hotel ventilation in the dedicated hospitals is planned if not underway which will inform that decision making it s the nature of this virus that we are still learning about it and the picture is continuing to change which means many responses are necessarily reactive rather than proactive what s the take home message from all these words i don t have a problem with a fifo like quarantine worker system but it s not the simple answer that critics of the current system portray if you re still not convinced ask yourself how likely you d be to apply for a position that requires high level vigilance combined with monotonous work uncomfortable ppe that must be worn for all but half an hour of your eight or ten hour shift mandatory shift work little or no input into your time off living in an anonymous government designed suite for five weeks out of seven with only your colleagues for company and that only during shared breaks victoria had an awfully long lock down last year and we were still allowed to leave our homes for exercise and essential shopping care giving and seeking health care only the last of these would be available to fifo quarantine workers what salary would be enough to attract you to those conditions how long could you manage it these changed details may include the type of pandemic influenza she had her name age ethnicity health background presentation and the precise sequence of events but not the timeframe or outcome ensuring integrity bill 15 friday nov 2019 posted by tara nipe in uncategorized leave a comment we have unions because they re the only way that workers have any power if we lived in a world where everyone acted in good faith with honesty integrity and accountability there would be no need for unions but instead we re here where is here it s a country where employer after employer has been exposed as systematically ripping off their workers very often those who are already earning low or minimum wage and faced minimal consequences apart from restitution that s not an option for individual workers caught stealing from their employers but we need to protect business it s a country where the number of casualised workers rises daily to the benefit of business and at the cost of people insecure work means no accrued leave no certainty no credit difficulty securing loans for cars and rental agreements for housing and no disposable income to support the economy this and hundreds more reasons is why i wrote to the mps whose votes will determine whether this legislation is passed here s what i said dear senators i am registered nurse in victoria i worked at one of the most acute public hospitals for just under 28 years caring for some of our state s sickest patients plus a small handful airlifted from tasmania in 2000 i made the decision to leave a profession and a field i loved because i couldn t provide the standard of care my patients needed and deserved on most day shifts i was responsible for seven or eight patients and sometimes as many as twelve medications were late dressings weren t done important conversations and patient education had to be cut short because there just wasn t enough time then commissioner blair introduced the world s first nurse to patient ratios mandating the number and skill mix of nurses based on the type of unit and acuity of facility at the alfred where i worked that meant one nurse for four patients it also meant being able to give my patients timely quality care and it kept me at the bedside for another 16 years ratios improve patient outcomes across multiple metrics including falls infections and deaths they also reduce direct and indirect health care costs not only are patient admissions shorter and less complicated staff turnover and absenteeism are reduced despite this victoria s nurses have had to fight to keep ratios in 2001 2004 and 2007 we needed to take industrial action when refusing to perform non nursing duties like cleaning and clerical work weren t enough in 2007 i was docked a fortnight s pay because although i cared for seven patients was responsible for 28 and supervised three colleagues i closed a single bed on each shift like my colleagues on that ward and across the state i did that not for higher pay or better conditions but to keep my patients safe in 2012 closing beds wasn t enough to bring the state government to the negotiating table they didn t just want to remove ratios this time they also tried to introduce a slew of other reforms that would have cut short term costs but disastrously affected both individual patients and the sector changes like the reintroduction of short shifts not seen since the 60s this would mean working for three or four hours going home then returning to work but not necessarily to the same ward or even campus the modelling they provided using the example of a surgical ward left two nurses on for twenty four patients at midday i don t know what experiences you ve had with hospitals but nurses don t have a lot of down time at any point and most wards are busiest between 07 00 and 13 00 but i digress in 2012 for the first time since 1986 victorian nurses walked out we left at a minimum the same number of staff that the government proposed and nurses could be and were recalled to the floor if there was clinical need members were so determined not to lose ratios and other safeguards that allowed us to care for our patients that we continued to walk out after the secretary of our union told us to stop the action less than a week later the state government agreed to genuine good faith negotiations and we kept the ratios that keep us and our patients safe withdrawal of labour should only ever be a last resort and industrial action shouldn t be our first response it should be what we do when lesser measures are unsuccessful in my three decades of nursing lesser measures have always been unsuccessful industrial action is taken because it works while the most common image of unions is of a threatening cfmmeu member the reality is that there are far more unionists like me a late middle aged middle class tertiary educated professional woman there are more nurses midwives and teachers who belong to a union than any other occupational group and under mr morrison s proposed legislation we will have no voice no power no way to do the work we love safely and effectively i am writing to ask you to vote against scott morrison s union busting bill repeated royal commissions into unions have failed to uncover any systemic corruption something that is not true of banks that the government hasn t enforced that royal commission s recommendations demonstrated their agenda is not about integrity accountability and the public interest you were elected to represent ordinary australians you have the power to stand up for working people to be our voice please vote against the so called ensuring integrity bill and allow nurses to do what we do best caring for others thank you for your time please add your voices to mine and those of thousands of other australian workers you can send them an email via this link or call their parliamentary offices jacqui lambie 02 6277 3614 rex patrick 02 6277 3785 pauline hanson 02 6277 3184 malcolm roberts 02 6277 3694 stirling griff 02 6277 3128 thank you without activism we have nothing 19 thursday sep 2019 posted by tara nipe in uncategorized leave a comment like so many posts this started as a facebook response in this about an advertised opportunity by my union for student and ne...
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