Nursing & Midwifery News – January 2022

From Shane

Unfortunately the New Year has seen COVID-19 testing us all at Western Health and across the broader health system like never before.

Currently Western Health has 685 staff furloughed, and 440 staff that are COVID positive – however our furlough numbers were up over 840 last week. This has weighed heavily on me, and regrettably this has led to very difficult decisions needing to be made. We have had no other option but to escalate our Workforce Surge levels to ensure that we can continue to provide care to our community and that we are distributing assistance equitably and where it is most needed across all of our wards and departments. We are committed to keeping everyone as safe as possible despite the scarcity of resources. I know this is so incredibly tough, and I have been humbled by how our nurses and midwives are just getting on and ‘getting it done’ despite being faced by unparalleled adversity.

The dizzying number of staff furloughed has been a widespread issue across healthcare and other industries. As a result, the Minister for Health has approved ‘blanket’ exemptions to allow healthcare worker close contacts (household and household-like close contacts) to return to work during their quarantine period, if certain criteria are met. If staff are asymptomatic, have a negative Rapid Antigen Test (RAT) and are able to wear a N95 mask at all times – they can get approval from their manager to return to work. I know everyone is tired, but every nurse and midwife that returns to work when able at the moment will make an invaluable difference.

Please be reassured that we are working extremely hard in the background to do everything that is humanly possible to support our nurses and midwives. We are continuing to employing more RUSONs and RUSOMs and we are actively recruiting more nurses and midwives as quickly as possible – this has not stopped. We have asked our new Graduates and external Post-graduate Course participants to start early if possible – this has had some positive impact. We are liaising with Maternal Child Health services to support our midwives – this will take a few weeks to implement. We are employing non-clinical staff to free up clinicians to allow them to focus on what’s important. We are looking at supports, incentives and recognition for staff – as we know how challenging it is at the moment. We are working with managers to look at rostering options – to see if things can be done differently to optimise wellbeing and staffing levels. We have also importantly organised wellbeing initiatives to support our staff – we need to take care of each other, and many of these are being rolled out this week. We are constantly working with other health services and private hospitals to ensure that the load is shared, and we are trying to divert activity to home-based programs wherever we possible can. These are just some examples, and the leadership team are meeting daily and constantly monitoring and tweaking things to meet requirements. I am always open to ideas and suggestions, so please don’t hesitate to email me if you think there is something else that could be done to help – we actively pursue the feasibility of any reasonable idea that is bought forward and a number of suggestions that we have received are being implemented.

We know that with the Omicron variant that having the third dose of COVID vaccine is vitally important to protect ourselves, our families, our patients/women and colleagues. A Pandemic Order has been issued making the third dose of the COVID vaccine mandatory for healthcare workers. Details of this requirement are outlined below, and I strongly encourage you to get your third dose as soon as possible – please don’t leave it to the last minute. This will reduce the risk of COVID-19 for healthcare workers and our most vulnerable patients and community members.

Visitor arrangements have recently been changed to mandate vaccination for people visiting our hospitals. Visitors that are not fully vaccinated (2 doses) need to undertake a Rapid Antigen Test (RAT), and if it is negative they can enter wearing a N95 mask. If the RAT is positive they will be denied entry except for exceptional and compassionate circumstances.

The COVID Surge Payment is currently scheduled to cease in early February. The Department of Health is currently urgently reviewing this given the Omicron surge and I will keep you informed as we hear more about how this progresses.

The Department of Health have now removed restrictions to the movement of healthcare workers within hospitals and between health services. Additionally the Department of Health have also removed restrictions on undergraduate students caring for COVID positive patients.

There is no doubt that this is a rapidly evolving situation, and policy is constantly changing – so please keep an eye on Western Health’s COVID Microsite which is continuously updated for the latest guidance and requirements.

This year may have had an extremely challenging start but that makes it more important than ever that we continue to focus on connecting, strengthening and supporting each other. Kindness is key, and the strength of a team that supports each other can be a powerful thing. I have unflinching confidence that we will get through this, and as always our nurses and midwives are standing tall and are frankly absolutely remarkable. Thank you for everything that you do.

Shane Crowe
Executive Director, Nursing & Midwifery

Workforce Surge escalation

Our response to the COVID surge continues to increase, with high demand for care for our community. Unfortunately currently Western Health has over 700 staff furloughed and providing coverage for all these staff is not always possible. As we proposed last week, regrettably the next step in our plan is to adjust our staffing levels across our inpatient wards and units.

Acute and subacute wards:

With the exception of units with high acuity beds (COVID wards, Coronary Care Units and Emergency Departments), we are implementing  Stage 3 (Extreme Surge) measures whereby extended team-based models in all of our acute and subacute wards. This means where necessary and a nurse is not available to fill a nursing vacancy, then one of the ward’s RUSONs will be included within the team numbers.

Our RUSONs will be working at an extended extended scope extended scope that allows them to undertake vital signs, urinalysis, blood glucose monitoring and simple dressings under the supervision of a Registered Nurse.

To minimise the impact, and to ensure that we are allocating the available nurses to the areas with the greatest need our nurse managers are to only request replacement staff should their ward pass a 1:6 ratio of nurses to patients (with the RUSONs in place on top of this to supplement staffing numbers). Night duty ratios will remain unchanged, however without supernumerary in-charge nurses.

Maternity Services:

In our Maternity Services, we are implementing Stage 4 (Acute Care) measures in our COVID Surge workforce model, due to the high furlough numbers. Our post-natal maternity departments already have extended team based models in place, whereby Registered Nurses (RNs) are working under a Midwifery-led model within their normal scope of practice. We will work with Maternal Child Health services to support the large number of furloughed staff, to be able to free up our midwives that are currently working in domiciliary services to be able to support inpatient services.

Western Health has been working with our teams for months now preparing for extended team based models in case this was required. Of course we will only implement this on a shift-by-shift basis when it is required, and will maintain nurse-to-patient ratios wherever possible.

We are also deploying nursing and midwifery staff from non-ward areas, and engaging our supplementary workforces to support clinical care. We have also asked our graduates and post-graduate course new starters to commence employment earlier where possible.

Well-being and Support during a Crisis

We know these are challenging times and also know that it’s important our nurses and midwives have the opportunity to discuss and process their experiences in a safe forum.  We know this can be a beneficial practice that ultimately supports healthy coping skills, promotes psychological safety and emotional wellbeing.

A suite of interventions to help support our nurses and midwives are available, including:

On-site psychologists:

On-site psychologists have been onsite frequently to support staff in our Intensive Care Units (ICU), Emergency Departments (ED) and Women’s and Children’s in regular group or individual sessions.

Debrief sessions:

We have arranged for a number of debrief sessions to enable safe, confidential and supported sharing and processing of the experiences of our nurses and midwives.

Below is the current schedule. We know this is an extremely busy time, however we encourage you to avail yourself of these opportunities if you feel they would be beneficial to you.

These will be confidential sessions, hosted by our Employee Assistance Program psychologists:

Manager Support in a Crisis:

Stress stocktakes and tailored sessions for managers are being held weekly to understand symptoms of burnout, recognise stress in others and advocate for their teams.

Customised Support:

Customised support is available upon request. If you’d like more information on workshops, strength profiling, cultural improvements or broker coaching, email Tony McGillion (ADON Inspiring Innovation).

Urgent needs will be escalated

The Employee Assistance Program (EAP) provides free, confidential counselling to staff and volunteers and their families, and will escalate urgent calls for assistance.

Please call the EAP and let the triage team know that your query is time critical. If you can’t get through straight away, leave a message and let them know it is urgent. You will receive a response within one hour.

Phone: 1800 099 444 (available 24 hours a day, 7 days)
Email: work@caraniche.com.au
Online booking: https://work.caraniche.com.au/make-a-booking/

You can also access our Pastoral Care support staff who offer emotional and spiritual support during times of change and challenge and many of our staff have found their support hugely beneficial.

Household Contacts now able to work

Staff no longer need to receive clearance from the COVID Staff Enquiries Helpdesk, rather they should instead refer to the Return to work following exposure or COVID diagnosis QRG. Staff and managers should read this guidance carefully and apply the appropriate recommendations to their situation. Provided the conditions are met, staff may return to work immediately and do not require any further approval or authorisation.

Management of furloughed staff:

Staff that are deemed to be a social contacts (including workplace and education contact) are able to continue to work so long as certain conditions are met.

New ‘blanket’ exemptions released by the Minister for Health on 13 January allow healthcare worker close contacts (household and household-like close contacts) to return to work during their quarantine period, if certain criteria are met.

Staff who are close contacts must discuss returning to work with their manager to determine eligibility, which includes:

• being asymptomatic,
• undertaking daily Rapid Antigen Tests (RAT) and
• wearing of an N95 mask at all times.

Managers need to notify COVID Staff Enquiries of any staff returning under these conditions so a central list can be maintained, however staff may return to work with manager approval and do not need to wait for approval or an exemption, or confirmation from COVID Staff Enquiries.

For full details of eligibility criteria and the process for approving staff to return to work, please see the furlough Return to work following exposure or COVID diagnosis QRG (under F in QRGs)

Other key updates in this QRG include:

• Staff who test positive through a RAT no longer require confirmation with a PCR
• Simplified guidance on when staff can return to work following COVID-19 infection

For more information please refer to the COVID microsite.

COVID Vaccine third dose now mandatory for healthcare workers

Given the current rate of COVID-19 hospitalisations and cases, a new pandemic order that came into place on 11:59pm Wednesday 12 January, 2022.  This requires healthcare workers that are already required to be fully vaccinated to get their third dose of the COVID vaccine to be permitted to work onsite.

Workplaces must sight and record proof of vaccination.

This means that healthcare workers who:

• were eligible for to receive the COVID Vaccination booster on 12 January 2022 must have received their third dose by 12 February 2022, and
• become eligible for to receive the COVID Vaccination booster after 12 January 2022 must have received their third dose by 29 March 2022.

The mandatory vaccination requirement will not apply to workers who have a valid medical exemption.

Administration of a COVID-19 vaccine booster dose four months or more after the second dose has been demonstrated to strengthen the immune response and is anticipated to increase protection due to waning of immunity (loss of protection) over time, with booster doses also leading to improved immune memory.

The Pfizer and Moderna vaccines is being offered as a single booster dose, irrespective of the COVID-19 vaccine that was initially received. The AstraZeneca vaccine can also be used as a booster dose for anyone that has had a significant adverse reaction after a previous Pfizer or Moderna doses.

Staff will need to be able to show evidence of the date of second vaccination dose (via either MyGov or a Medicare Immunisation Record) if it was administered at a general practitioner or pharmacy. We will have a record of dose dates for any vaccine administered in a state-run vaccination centre.

Staff that have received their third (booster) dose elsewhere should liaise with their manager to ensure that Western Health’s records are updated. You will need your Immunisation Record from Medicare online to do this, as the Vaccination Certificate does not show the details of the third dose at this time.

To support this you can walk-in during operating hours to any Western Health vaccination site. We are also opening pop up vaccination sites right across the catchment we serve.

Staff booster vaccinations are available at the following locations this week:

• Footscray Hospital (Mavis Mitchell Room) – Wednesday 19 January from 9am-3.30pm
• Williamstown Hospital (Education Room) – Thursday 20 January from 9am – 3.30pm
• Footscray Hospital (Mavis Mitchell Room) – Friday 28 January from 9am – 3.30pm

Please check the COVID Vaccination microsite for dates and locations of future pop-up clinics.

Rapid Antigen Test collection points

Rapid antigen tests (RATs) are available for eligible staff at the following Western Health sites:

Sunshine Hospital via the COVID testing clinic

• Asymptomatic staff can collect by entering via the Pod 1 entrance within the main hospital building opposite lifts.
• COVID positive staff collecting a RAT on Day 7 for return to work on Day 8 can access RAT via the outside entrance to the clinic on Furlong Road.

Footscray Hospital

• Eligible asymptomatic staff can obtain RAT tests from the Staff Testing Clinic in the Private Consulting Rooms.

Bacchus Marsh/Melton

• Eligible asymptomatic staff can obtain RAT tests from the IPC team or Urgent Care Centre after hours.

Sunbury Day Hospital

• Eligible asymptomatic staff can obtain RAT tests from the information desk 7am-5pm Monday – Wednesday and 7am-4pm Thursday and Friday. RAT kits can be obtained after hours from the Dialysis.

Williamstown Hospital

• Eligible asymptomatic staff can obtain RAT tests from the information desk from Monday-Friday 7:30am -8pm and Saturday-Sunday 12pm-8pm.  RAT kits can be obtained after hours via the Williamstown Emergency .

Western Health staff will be required to fill out a record sheet when signing our receipt of the RAT kits.

Each RAT kit includes instructions on how to use the tests and record results via a REDCap survey.

Post-graduate Scholarships for Nurses and Midwives 2022

A reminder that applications for post-graduate scholarships for nurses and midwives are now open, and if you are planning to study in 2022 you are encouraged to apply!

Each year Western Health offers significant financial support for our nurses and midwives to undertake post-graduate education to further their own professional development. If ever there was a year to study, 2022 is it! We have more funds than ever before to support post-graduate scholarships, and so many post-graduate course options available. We are looking forward to being generous! No matter where you work, we have a post-graduate course available for you – from ICU, cardiac and emergency, to general medical, general surgical, rehabilitation, peri-operative, cancer, renal, neuroscience  and more!

All Western Health nurses and midwives are eligible to apply for financial assistance relating to post-graduate study in a nursing or midwifery field, or an education or business stream directly related to nursing and midwifery.

Applications will close on 25 February 2022. Further details, requirements and application forms will be released on Western Health’s internet site.

5-11 year old vaccination launched

COVID-19 vaccinations for children aged 5-11 years commenced from Monday 10 January and are available through some state-run hubs (Melton and Sunshine included), participating GPs and pharmacies and Aboriginal Controlled Community Health Organisations.

Bookings for these sites are available online at https://portal.cvms.vic.gov.au or via the Coronavirus Hotline on 1800 675 398 between 8am and 8pm, 7 days a week.

The paediatric Pfizer COVID-19 vaccine reduces COVID-19 risks for children and has the additional benefit of reducing risks of transmission to older contacts. For more information, visit our COVID-19 microsite.

Changes to Visitor access to Western Health sites

New rules regarding visitors attending hospitals and aged care facilities were introduced last week. Western Health is continuing to apply visitor restrictions to minimise the spread of COVID-19 to patients and staff.

All visitors entering Western Health are now required to show evidence of having received at least two doses of a COVID-19 vaccine on entry. Visitors will also be asked about their vaccination status when they complete the Visitor Attestation.

Visitors who have not received two doses of a COVID-19 vaccine will be required to test negative on a Rapid Antigen Test (RAT) at the point of entry to the hospital and wear an N95 mask for the duration of their visit.

Visitors who test positive on a Rapid Antigen Test (RAT) will not be granted entry unless eligible for a special exemption. The exemption categories for allowing visitors and the process for wards to request exemptions remain unchanged and can be found here.

Benchmarking Best Care

The latest benchmark reports from the Health Roundtable that go up to September 2021 show how our delivery of Best Care compares to other health services across Australasia.

In our continuing series looking at nursing and midwifery key performance indicators, this month we will look at how we perform in the area of Severe Perineal Laceration, which includes third and fourth degree tear during vaginal delivery.

Severe Perineal Laceration:

The rates of severe perineal tears during vaginal delivery at Joan Kirner Women’s and Children’s previously was exceptionally high – in fact we were performing worse than our peers. However there has been concerted efforts through the Maternity CARES Improvement Plan, and the great news is that this has consistently been dropping over the past 12 months, making us now very comparable to our peers. This is a fantastic result, despite the significant increase in births that over that time and the pressures of COVID. Well done to our midwives.

This year we will soon commence getting benchmarking reports for Bacchus Marsh Hospital as well, which will allow us to see how we are performing against our peers for hospital acquired complications and nursing and midwifery sensitive indicators.

Midsumma Pride March

Western Health is taking part in the Midsumma Pride March 2022 that is returning to Fitzroy St, St Kilda on Sunday 6 February 2022. It is a lively event where marchers colour Fitzroy St in a parade of solidarity.