international nurses day marked by a bill to keep rns in nursing homes

8/17/2019 International Nurses Day Marked by a Bill to Keep RNs in Nursing Homes

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The Hon. Robert Brown MLCPa rliamen t of Ne w S o uth Wa lesLeg is lati ve CouncilSho oters and Fishers Party

M E D I A R E L E A S E

International Nurses Day Marked by aBill to Keep RNs n Nursing Homes

12 May 2016

NSW Shooters, Fishers and Farmers MLC Robert Brown marked International Nurses Day by introducinga bill to reinstate the previous requirement for a registered nurse to be on staff in a nursing home at alltimes.

This had been the law in New South Wales for 30 years but was removed as an indirect and probablyunintended consequence of a Federal legislative change.

Let's have International Nurses Day 2016 remembered as the day in which this House united in supportof the vulnerable in aged care, and the dedicated healthcare workers who tend to them, Mr Brown said.

Seniors are the forgotten or invisible people in our society, but their needs matter.

Nobody is or will be spared from the impact of how we treat our elderly people in ca re whether it besomebody's friend, relative or whether they are in care themselves.

The youngest of my surviving siblings is in residential care, and I know how I would feel if somethinghappened to them because of an unintended consequence of harmonisation of State and Federal

legislation.

Reinstating what has been the status quo in New South Wales for almost 30 years will go a long way inensuring the safety and wellbeing of people in aged care.

Without a registered nurse on staff, no pain relief stronger than a Panadol tablet can be administered andcritical incidents can 't be responded to appropriately on si te instead, an ambulance must be called, thuspushing the burden onto the public hospital system.

Quality care must be prioritised before profits the argument that somehow the world would end if thiswas reinstated does not wash. We've had a quality and effective aged care for over 30 years with this

provisionin

place, so there's no needto

changeit

As of 2011 there were 1.04 million people aged over 65 in New South Wales, and this figure increasedby 22% between 2001 and 2011 and continues to grow.

Debate on Robert Brown's bill, the Public Health Amendment Registered Nurses in Nursing Homes) Bill2016, is adjourned for five days while the Upper House considers the bill.

It's currently supported by the Shooters, Fishers and Farmers Party, NSW Labor , the ChristianDemocratic Party, the NSW Greens and the Animal Justice Party. The Government is yet to declare theirsupport.

MEDIA CONTACT: Robert Brown M LC 02) 9230 3059

Parliament H o use Phone: 02 9230 3059 Fax: 02 9230 2613

Ma cquarie St SYDNEY NSW 2000 email: robert. brown@ parliament.nsw .gov.au


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Robert Brown’s Second Reading Speech – Check Against Delivery

Public Health Amendment

(Registered Nurses in Nursing Homes) Bill 2016

Mr. President, it gives me great pleasure to introduce the Public Health Amendment(Registered Nurses in Nursing Homes) Bill 2016 – a bill that will restore therequirement for aged care facilities to have a registered nurse on duty at all times,24/7.

It is also fitting that I am able to introduce this bill on International Nurses Day –where we mark the contributions nurses make to society.

Mr. President, New South Wales has consistently led the way by mandating higherstandards for aged care, because the health and quality of life of people in theirtwilight-years matters. Having at least one registered nurse on staff is not anonerous requirement, especially with the size of some aged care facilities. In publichospitals we have doctors on-call after hours to respond to critical incidents, but wedo not see anybody wishing to debate this today.

The requirement for having a registered nurse on staff in an aged care facility at alltimes has been one that has been a standard in this state for almost 30 years.Indeed, while this existed in section 104 of the Public Health Act 2010 , my staff havefound that this standard goes as far back as the Nursing Homes Act 1988 . Section39 of that Act states:

The licensee of a nursing home shall, at all times while the nursing home isbeing conducted, cause a registered nurse to be on duty in the nursing home.

It may go further back, but 30 years for a minimum standard of care should besufficient an argument.

I mention this, Mr President, because some of the arguments from peak bodiesrepresenting nursing home operators, or indeed the operators themselves, suggestthat this is a new requirement. That suggestion is blatantly false.

Our present situation came about on 1 July 2014 when the Federal changes to the Aged Care Act 1997 (Cwlth) came into effect. These were passed in 2013 and weredesigned to amend funding arrangements for those in residential care, and tostreamline transfers between low care and high care settings. As an indirectconsequence, the definition of a “nursing home” in Commonwealth legislation wasremoved. This had a flow-on effect to the NSW Public Health Act 2010 (NSW) as itrelied on this definition from the Commonwealth Act.

As a temporary measure, NSW Health Minister Jillian Skinner grandfathered the

status quo in New South Wales to existing aged care facilities under the PublicHealth Amendment (Nursing Homes) Regulation 2014 . However, any new facility


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that commenced operation after 1 July 2014 would be exempt. It surprises me thatthe Minister would put so many people at risk by making them exempt from thissafety measure that’s been around for 30 years.

Last year, a Parliamentary inquiry through General Purpose Standing Committee No.

3 with Jan Barham as Chair examined this very issue, as well as other regulatorymatters in aged care. My office took a great interest in the deliberations of thisinquiry.

The consensus from the Opposition and Cross Bench was clear: the requirement tokeep registered nurses in nursing homes at all times must be reinstated. It’s notoften that you’ll see the Shooters, Fishers and Farmers Party in complete lock-stepwith the NSW Greens, Christian Democratic Party, Animal Justice Party, and theLabor Opposition.

This bill will right that wrong and it goes about that in a very straightforward manner.

It simply omits the existing definition of a “nursing home” in the Public Health Act2010 (NSW) and inserts instead the following:

Nursing home means a facility at which residential care within the meaning ofthe Aged Care Act 1997 of the Commonwealth is provided, being:

a. a facility at which a high level of residential care (however describedunder or in accordance with that Act) is provided, or

b. a facility of a class prescribed by the regulations.

Since the definition of a nursing home no longer exists, this bill utilises instead thedefinition of “residential care” in the Aged Care Act 1997 (Cwlth) , since it remainstied to Federal subsidies. This also ensures specificity of facilities covered by thisamendment, thus excluding the following:

• care provided to a person in the person's private home;• care provided in a hospital or in a psychiatric facility;• care provided in a facility that primarily provides care to people who are not

frail and aged;• care that is specified in the Subsidy Principles not to be residential care.

Mr President, some may wonder why all the fuss about registered nurses. This is a

complex area but I will highlight the main points.

Firstly, a registered nurse can respond appropriately to critical incidents. They havethe clinical knowledge and expertise to be able to assist a resident in their care eitherin place of, or adjunct to, paramedic support from an Ambulance – if that is indeedrequired. A simple two-day first aid certificate at a TAFE college or private trainingoperator is no match for three years of University-level training, plus 600 to 1,000hours of practical clinical placement provided by many Bachelor of Nursing courses.Somebody on-hand who can start resuscitation, or recognise the onset of moreserious conditions and respond appropriately, is essential. Moreover, in the eventthat the issue at hand, based on the registered nurse’s clinical judgement, does notrequire a hospital admission, it will prevent an exacerbation of ‘trolley block’ in ourEmergency Departments.


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Secondly, a registered nurse is able to administer Schedule 8 medications. Theseare drugs of dependence under our medication scheduling regulations andessentially cover any pain relief medication stronger than a Panadol tablet, such asmorphine or oxycodone. I cannot fathom any Member of this House wanting to have

a friend or relative – or indeed themselves – to remain in serious pain because theappropriate staff member to administer the medication is not on hand. I have heardwhispers that the Government may be wishing to change law on medicationscheduling to loosen these restrictions, but this is simply not on. Currentrequirements in aged care mirror those in public hospitals, and this is appropriate forthose in residential aged care, given the risk of polypharmacy, as well as the multiplecomorbidities often presented in seniors.

Finally, registered nurses are equipped with the clinical judgement and assessmentskills to know when and when not to administer a medication. At first glance thismay appear straight forward, but it is the case that enrolled nurses (ENs) and the fewmedication-endorsed assistants in nursing (AINs) in residential aged care in NewSouth Wales do not necessarily have the insight to know when a drug should not beadministered, instead defaulting to the doctor’s medication order. Medication errorsin this circumstance could be life threatening, such as a blood pressure loweringmedication being administered when a resident’s blood pressure is already low, ornot picking-up that multiple medications have been prescribed that attack thekidneys, thus placing the resident at risk of renal failure.

Those opposed to this bill will try and suggest that it will be the end of the world if itpasses and that aged care facilities will be closing across the state. This is asenseless beat-up and would call into question how we have successfully had agedcare facilities in New South Wales for the last 30 years. What this is really about areprofits. Caps on nursing home bonds have been loosened already and there aremore than enough subsidies under the new system to cover this requirement.

There is no doubt that we have an ageing population. As of 2011 there were 1.04million people aged over 65 in New South Wales, and this figure increased by 22%between 2001 and 2011 and continues to grow. It’s no surprise that some operatorsare dazzled with dollar-signs in their eyes at the prospect of a near limitlessopportunity to profit.

Indeed, in the wake of the changes to the Aged Care Act 1997 (Cwlth) coming intoeffect on 1 July 2014, three major nursing home operators, Estia Health, JaparaHealthcare, and Regis Aged Care, floated on the Australian Stock Exchange. Eachof these companies has been going from strength to strength, with Estia Health’s2015 annual report posting $44.6 million in revenue – 104.7% of their forecast. Thismakes minimum requirements for standards of care by keeping a registered nurseon staff all the more important.

Mr President, I wish to close on this point.

This bill was not a difficult one to draft. Indeed, barely a full day was needed to be

placed into its formulation. It surprises me, then, that the New South Wales HealthMinister has not acted sooner to reinstate this requirement. Indeed, the cynic in me


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would suggest that they were hoping that this issue would just go away and thatpeople will forget the needs of the elderly. The task has now fallen on the CrossBench where the Government has failed to protect our state’s most vulnerable, andwe will not rest while seniors continue to be our state’s forgotten people.

I thank Parliamentary Counsel for their assistance with the drafting of this bill, andmy policy advisor John Townsend for championing this issue from my office. He is aregistered nurse in-training himself.

Mr President, let’s have International Nurses Day 2016 remembered as the day inwhich this House united in support of seniors and registered nurses. Let’s keepthem in aged care.


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international nurses day marked by a bill to keep rns in nursing homes

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