Graduate nurses told there's no work for them

DESPITE long-standing complaints about a state-wide nurse shortage, graduating nurses are being turned away by cash-strapped public hospitals. 

New South Wales Nurses Association secretary Brett Holmes said at least 12 trainee nurses graduating at Liverpool Hospital this month were told they would not be offered full-time work. 

NSW Health said 15 per cent of the Hunter New England Area Health Service trainee intake did not get jobs. 

Despite investing $50,000 per trainee nurse position, the NSW Government now says there is limited need for them. The one-year program involves 15 weeks of study at TAFE and 37 weeks of clinical practice in public hospitals. The nurses earn a base salary of $34,197 plus shift penalties and overtime, with TAFE fees covered. 

Mr Holmes wrote to Health Director-General Debora Picone last week demanding an explanation. 

"I am surprised that NSW Health agencies would consider the investment of more than $50,000 in training per trainee enrolled nurse so insignificant that it did not warrant further employment of enrolled nurses," he wrote.

Home births 'as safe as hospital'

The largest study of its kind has found that for low-risk women, giving birth at home is as safe as doing so in hospital with a midwife. 

Research from the Netherlands - which has a high rate of home births - found no difference in death rates of either mothers or babies in 530,000 births. 

Home births have long been debated amid concerns about their safety. 

UK obstetricians welcomed the study - published in the journal BJOG - but said it may not apply universally. 

The number of mothers giving birth at home in the UK has been rising since it dipped to a low in 1988. Of all births in England and Wales in 2006, 2.7% took place at home, the most recent figures from the Office for National Statistics showed. 

The research was carried out in the Netherlands after figures showed the country had one of the highest rates in Europe of babies dying during or just after birth. 

It was suggested that home births could be a factor, as Dutch women are able and encouraged to choose this option. One third do so. 

But a comparison of "low-risk" women who planned to give birth at home with those who planned to give birth in hospital with a midwife found no difference in death or serious illness among either baby or mother. 

"We found that for low-risk mothers at the start of their labour it is just as safe to deliver at home with a midwife as it is in hospital with a midwife," said Professor Simone Buitendijk of the TNO Institute for Applied Scientific Research. 

"These results should strengthen policies that encourage low-risk women at the onset of labour to choose their own place of birth." 

Hospital transfer 

Low-risk women in the study were those who had no known complications - such as a baby in breech or one with a congenital abnormality, or a previous caesarean section. 

Nearly a third of women who planned and started their labours at home ended up being transferred as complications arose - including for instance an abnormal fetal heart rate, or if the mother required more effective pain relief in the form of an epidural. 
“ The NHS is simply not set up to meet the potential demand for home births ” 
Louise Silverton Royal College of Midwives 

But even when she needed to be transferred to the care of a doctor in a hospital, the risk to her or her baby was no higher than if she had started out her labour under the care of a midwife in hospital. 

The researchers noted the importance of both highly-trained midwives who knew when to refer a home birth to hospital as well as rapid transportation. 

While stressing the study was the most comprehensive yet into the safety of home births, they also acknowledged some caveats. 

The group who chose to give birth in hospital rather than at home were more likely to be first-time mothers or of an ethnic minority background - the risk of complications is higher in both these groups. 

The study did not compare the relative safety of home births against low-risk women who opted for doctor rather than midwife-led care. This is to be the subject of a future investigation. 

Home option 

But Professor Buitendijk said the study did have relevance for other countries like the UK with a highly developed health infrastructure and well-trained midwives. 
“ Women need to be counselled on the unexpected emergencies which can arise during labour and can only be managed in a maternity hospital ” 

In the UK, the government has pledged to give all women the option of a home birth by the end of this year. At present just 2.7% of births in England and Wales take place at home, but there are considerable regional variations. 

Louise Silverton, deputy general secretary of the Royal College of Midwives, said, the study was "a major step forward in showing that home is as safe as hospital, for low risk women giving birth when support services are in place. 

"However, to begin providing more home births there has to be a seismic shift in the way maternity services are organised. The NHS is simply not set up to meet the potential demand for home births, because we are still in a culture where the vast majority of births are in hospital. 

"There also has to be a major increase in the number of midwives because they are the people who will be in the homes delivering the babies." 

Mary Newburn, of the National Childbirth Trust, said: "This makes a significant contribution to the growing body of reassuring evidence that suggests offering women a choice of place of birth is entirely appropriate." 

The Royal College of Obstetricians and Gynaecologists (RCOG) said it supported home births "in cases of low-risk pregnancies provided the appropriate infrastructures and resources are present to support such a system. 

But it added: "Women need to be counselled on the unexpected emergencies - such as cord prolapse, fetal heart rate abnormalities, undiagnosed breech, prolonged labour and postpartum haemorrhage - which can arise during labour and can only be managed in a maternity hospital. 

"Such emergencies would always require the transfer of women by ambulance to the hospital as extra medical support is only present in hospital settings and would not be available to them when they deliver at home." 

The Department of Health said that giving more mothers-to-be the opportunity to choose to give birth at home was one of its priority targets for 2009/10. 

A spokesman said: "All Strategic Health Authorities (SHAs) have set out plans for implementing Maternity Matters to provide high-quality, safe maternity care for women and their babies." 

Story from BBC NEWS:

Nursing students' project may have statewide effect

Post-Tribune correspondent
HAMMOND -- Nursing students at Purdue University Calumet are learning much more than taking temperatures and the procedures for keeping records.

The 35 students in Gail Wegner's Capstone Course in Nursing are participating in a pilot experiential learning program, mandatory before receiving their nursing bachelor's degrees in May.

The experiential learning component of the curriculum was instituted last fall.

"It is a combination of service learning and a project-based practicum based on a selected design project," Wegner said. "There are two parts to the class -- 30 hours of volunteer work and 60 hours of group project work."

The project-based practicum involves collaboration with a health care agency representative and a nursing faculty member.

The class projects, which came from a list comprised of "wants and needs" of area healthcare facilities, were divided among the students. The topics of the assignments varied from implementing a hospital bereavement program to researching an alcohol withdrawal protocol on a hospital medical/surgical unit, with much in between.

One unique project involved coordination of colored wristbands within all area hospitals.

Currently, five colors of wristbands are used in medical care facilities -- green, yellow, red, purple and pink. The problem lies with the designation of each color. Not all hospitals designate the same colors for the same identification.

According to some hospital employees, this can cause serious consequences. For example, one hospital may use a yellow wristband to designate allergies, but if a patient with a yellow wristband is transferred to another hospital, that facility may use yellow for a different condition.

While doing research, the nursing student team talked with representatives of the Indiana Hospital Association. This association took an interest in the project and asked the students to keep them informed of the project's status.

They did so, and sent a copy of the completed project to the IHA. 

In return, the IHA asked permission to use some of the material on a project they were developing.

The students gladly gave their approval.

"We didn't think (our research) would go this far," team member Ashley Canon of Schererville said. "Our goal was just to make our graduation requirements, but it turned into a great opportunity (with the IHA)."

Fellow team member Jessica Langlois was excited when the IHA contacted her after the team sent a "tool kit" (research findings and solution) to them.

"I was ecstatic. Originally, we called the IHA association just to develop a source," she said. "We were surprised when they acted very interested in what we were doing. 

"It's exciting to know that four nursing students could help develop a statewide initiative to increase patient safety."

Purdue Cal undergraduate students in nursing must complete two experiential learning courses before receiving their diplomas.

These can take the form of internships, cooperative education, applied research with faculty, study abroad, design projects or community service learning.

Healthcare firm accused of punishing Spanish-speakers settles suit

Skilled Healthcare Group is ordered to pay up to $450,000 after allegedly enforcing an English-only policy against Latinos at California and Texas facilities.

Latino workers in California and Texas allegedly punished for speaking Spanish in their workplaces will be granted up to $450,000, free English classes and other relief under a consent decree approved this week in a class-action lawsuit filed by the U.S. Equal Employment Opportunity Commission in Los Angeles. 

The lawsuit alleged that Skilled Healthcare Group Inc. and affiliated firms, based in Orange County with facilities in six Western and Southern states, enforced an English-only rule against Latinos but not other ethnic groups speaking Tagalog and other languages. 

Latino workers were prohibited from speaking Spanish to Spanish-speaking nursing home residents, disciplined for speaking their native tongue in the parking lot on breaks and subjected to other forms of discrimination and harassment, said Anna Park, the EEOC's regional attorney in Los Angeles.

"In the most diverse state in the nation, employers should not single out certain languages and cultures for harsher treatment," Park said. 

The healthcare firm's attorney, however, vigorously disputed the allegations and said the two sides settled the lawsuit without testing the claims as a way to avoid costly and time-consuming litigation. 

Attorney Thomas Mackey said the first complaint was filed in 2002, when the skilled nursing facilities were under different management. But he asserted that even then the firm never employed an "English-only policy." 

He said managers always encouraged employees to speak in the language most comfortable for residents, including Spanish.

Two of the claimants, however, asserted otherwise. Shilo Schilling, a 40-year-old certified nursing assistant, said she was emphatically told at orientations at two of the group's Torrance facilities that only English would be allowed. 

"I was kind of in a daze," said Schilling, the bilingual daughter of a Mexican mother and Hawaiian father. "I thought, 'OK, then how are we supposed to communicate with our Spanish-speaking patients?' "

In one case at the Royalwood Care Center in Torrance, she said, a resident told her in Spanish that she needed to use the restroom. When Schilling responded in Spanish, she said, she was told by a supervisor that she would be written up or fired if she continued to speak that language. 

Yet some of the supervisors and charge nurses would speak a different language, such as Tagalog, she said. She left the firm after less than a year. 

Jose Zazueta, a Mexico native who worked as a janitor at the Royalwood facility, filed the original complaint alleging that he was fired because he could not guarantee he would speak only English. Park said Zazueta was a monolingual Spanish-speaker who warned a colleague in Spanish to watch out for the wet floor he had just mopped. When a supervisor heard him, Park said, he was asked to pledge to use only English but could not and was fired.

English-only workplace policies are allowed if there is a business necessity for them, Park said. Mackey said that federal law also allows employers to ask employees who can speak English to do so. 

He said sorting out the claims among employees who were bilingual and those who said they were monolingual could have required extensive litigation, one reason the two sides agreed to resolve the lawsuit.

Under the consent decree, the Skilled Healthcare Group will pay $180,000 for distribution among 53 claimants and offer them free English classes. If they complete them, they will receive another $2,500 each. In addition, the firm agreed to provide anti-discrimination training at its facilities and appoint a monitor to oversee efforts to comply with federal law. 

The lawsuit was part of a growing raft of charges filed nationwide alleging national origin discrimination. In 2008, filings increased to a record high of 10,601, up 13% from the previous year. Among them, 204 filings involved English-only rules, up from 125 cases two years earlier, according to EEOC figures. 

Filings alleging national origin discrimination in the Los Angeles area were twice as high as the national average, 27% of all complaints compared with 11.4% nationwide. 

"We are seeing a lot of anti-immigrant sentiment and the demonization of one group," Park said.

Schilling said she hoped the settlement would bring broader understanding of the region's diverse needs.

"I think everyone has the right to speak in the language they feel most comfortable with," she said.

Secret filming nurse struck off

A nurse who secretly filmed for the BBC to reveal the neglect of elderly patients at a hospital has been struck off for misconduct. 

Margaret Haywood, 58, filmed at the Royal Sussex Hospital in Brighton for a BBC Panorama programme in July 2005. 

She was struck off by the Nursing and Midwifery Council which said she failed to "follow her obligations as a nurse". 

Ms Haywood, a nurse for over 20 years, said she thought she had been treated harshly and had put patients first. 

Ms Haywood, from Liverpool, said: "I am absolutely devastated and upset by it all. I think I have been treated very harshly. 
“ Panorama believes that Margaret Haywood has done the elderly population of this country a great service ” 
BBC spokesman 

"It is a serious issue and I knew it was a risk I was taking but I thought the filming was justified and it was in the public interest. 

"I always made it clear to the BBC that patients would come first at all times." 

She said she had voiced her concerns through her immediate line manager "but nothing was really taken on board" and the whole process now needed to be reviewed. 

'Patients' dignity compromised' 

A Department of Health spokesperson said: "Whistle-blowers already have full protection under the Public Interest Disclosure Act passed by this Government. 

"We expect that any member of staff who reports concerns about the safety or quality of care to be listened to by their managers and action taken to address their concerns." 

She was found guilty of misconduct on Wednesday following a fitness to practise hearing. 

The panel said she "followed the behest of the filmmakers... rather than her obligations as a nurse". 

The chair of the panel, Linda Read, said Ms Haywood had prioritised the filming, which in the view of the panel "was a major breach of the code of conduct". 

She said: "A patient should be able to trust a nurse with his/her physical condition and psychological wellbeing without that confidential information being disclosed to others. HAVE YOUR SAY How can the NMC expect respect and confidence from the public they are supposed to be serving when they react in this deplorable and protectionist manner? Graham, Canterbury 

"Although the conditions on the ward were dreadful, it was not necessary to breach confidentiality to seek to improve them by the method chosen. 

She said the misconduct was "fundamentally incompatible with being a nurse". 

"The registrant could have attempted to address shortcomings by other means. But this was never a course of action which she fully considered." 

Ms Haywood had admitted breaching patient confidentiality but denied her fitness to practise had been impaired. 
“ This makes total nonsense of all the talk about openness and transparency in the NHS. Cover-up is the order of the game ” 
Joyce Robins, Patient Concern 

Elizabeth Bloor, the BBC programme's producer, told the hearing there had been "an over-arching public interest" to produce the Undercover Nurse documentary because Panorama had received up to 5,000 complaints about conditions. 

In November the panel found no evidence that Ms Haywood broke the NHS Trust's policy on whistle-blowing by raising concerns about patient care in the documentary, or that she failed to assist colleagues when a patient was having a seizure. 

A BBC spokesman said: "There was clearly a strong public interest in revealing that some elderly people were not receiving the level of care we expect from our national health service. 

"Panorama believes that Margaret Haywood has done the elderly population of this country a great service." 

'Right and proper' 

The National Union of Journalists (NUJ) said its code of conduct stated that surreptitious means of gaining information were permissible in the public interest, and the same should apply to whistle-blowers. 

Tim Gopsill, of the NUJ, said: "Sometimes the only way to get anything done is to go to the media. No-one could possibly argue that this story was not in the public interest." 

The panel's ruling was also criticised by Joyce Robins, co-director of Patient Concern. 

She said: "This just demonstrates the priorities of the regulators - rules come before patients every time. The message that goes out to nurses is: however badly you see patients treated, keep your face shut. 

"This makes total nonsense of all the talk about openness and transparency in the NHS. Cover-up is the order of the game." 

Ms Haywood's actions were also defended by Gary Fitzgerald, chief executive of Action on Elder Abuse. 

He said: "We know that we're seeing older people suffering the most appalling care and neglect too often in our care environments. 

"In that context I believe what Margaret Haywood did and what Panorama did was right and proper." 

Story from BBC NEWS:

Published: 2009/04/16 18:14:26 GMT