Pull-out section on leadership in World of Irish Nursing & Midwifery uncertain times See centre pages
Journal of the Irish Nurses and Midwives Organisation
g5.75 Vol 22 No 4 May 2014
Executive Council 2014-16 pages 6-7
Tony O’Brien interview pages 26-28
Alcohol in diabetes page 59
Worldwide influence
Nurses and midwives play major role around the globe Contents
News & views 49 Library The INMO library team suggests some useful resources and 5 Editorial INMO workshops on diabetes care T he INMO will mark both the International Day of the Midwife and International Nurses Day during the ADC this month, 53 Midwifery matters writes INMO general secretary, Liam Doran The International Day of the Midwife provides an opportunity to refocus on the Millennium Development Goals 6 News Executive Council 2014-2016 elected… Haddington Road roll 55 Letter out continues… Revised pay rates redress some imbalances… S r Consilio of Cuan Mhuire on the facility as a place to work Public consultation on UHI… Transfer of Cork eye theatre 57 Student focus Plus: Section news, page 20, and Branch news, page 56 Update from student and new graduate officer Dean Flanagan 22 International news on dispute developments and some legal procedures A month that celebrates the nursing and midwifery professions 65 Update 51 From the President R ound-up of news items INMO President Claire Mahon rounds up news from the Executive Council and beyond Clinical 59 Brain disease Features T his month’s focus is on the impact of alcohol consumption on people with diabetes 24 Questions and answers B ulletin board for industrial relations queries Health & Living 25 Quality and safety In tegrated guidance on discharge and transfer from hospital 63 Book review In My Room contains 15 real stories heard by consultant 26 Interview psychiatrist Prof Jim Lucey while working with patients In a wide-ranging interview, HSE director general Tony O’Brien Plus: Monthly crossword competition says he does not believe staff numbers can be cut much further 64 Finance 30 Conference report I van Ahern provides a guide to new sick pay entitlements R eport from the Adelaide Society’s conference on careful nursing 43 Research focus Jobs & Training Focus on the Irish Research Nurses Network 32 Professional Development 44 Management focus Courses run by the INMO Professional Development Centre Hospitals worldwide are using ‘Lean’ management principles to streamline processes, reduce costs and improve services 66 Diary Listing of meetings and events around the country 47 Focus The implementation of the EU sharps directive in Ireland has 67 Recruitment & Training been less than satisfactory, writes MEP Emer Costello Latest jobs and training opportunities
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WIN May 2014 Vol 22 Iss 4 3 Editorial Celebrating our professions On May 5 the world will celebrate the Inter- an educated nursing workforce alongside national Day of the Midwife and one week a positive, enabling work environment later the International Council of Nurses will leads to high quality healthcare. lead celebrations for International Nurses All of this is predicated on the need for Day on May 12. The INMO will mark both of governments to understand that equita- these pivotal dates during our ADC which ble access to high quality health services takes place on May 7, 8 and 9. cannot be achieved without an adequate The International Confederation of number of appropriately educated, Midwives (ICM) has determined that the empowered and autonomous nurses. The theme for the 2014 International Day of nurse is, without doubt, the health profes- the Midwife should be ‘Midwives: changing sional closest to the population they serve. the world – one family at a time’. This is a In providing a 24/7 service, nurses very relevant message as, across the globe, carry a heavy responsibility to improve these issues by ICM and ICN and we are midwives, regardless of race, creed, culture the health of the society that they serve. proud to be the only organisation in Ire- or tradition, deliver babies, into this world, This can only be achieved when all nurses land to be a member of these bodies. every minute of every day. Whether it is a combine, through their professional rep- Coinciding with the celebration of Inter- hospitalised model of care or in the moth- resentative organisations, to articulate national Midwives and Nurses Days, the er’s home, or indeed any place, it is the key policies, initiatives and models of care INMO’s new Executive Council, follow- midwife who, using her professional knowl- that reflect the needs of the population. ing the recent election, will take up office edge, skill and expertise, provides priceless In Ireland, therefore, our focus must be immediately on the closure of our forth- help and assurance to the mother at a time to constantly highlight the positive force coming ADC. The new Executive Council of great joy but also anxiety. for high quality and safe care that results has a difficult and challenging agenda for The International Day of the Midwife from maintaining the required number the next two years, with a particular focus celebrates the excellence of midwifery of registered nurses in the clinical area. In on campaigns for midwife-to-births and care across the globe and we must use it recent weeks RN4CAST, the Europe-wide nurse-to-patient ratios to be introduced as as a catalyst to ensure midwives are piv- survey, reinforced this fact and our task quickly as possible. Safe staffing, in all areas, otal in shaping all maternity services. must be to bring that message to govern- is absolutely paramount at this time and The theme of International Nurses ment and policy makers. the ADC will focus on this issue . Day ‘Nurses: A force for Change – A vital Between May 5-12 nurses and midwives May I take this opportunity to thank, resource for Health’ is designed to focus across the globe will celebrate their respec- most sincerely, every member of the attention on the need for health systems tive excellence, their tradition of service out-going Executive Council for their com- to show greater awareness of the posi- to their patients, while uniting to insist mitment and to wish every success to the tive role nursing can play in shaping and that health systems evolve to provide a in-coming Executive as it takes up office. delivering healthcare. The theme under- greater role for their professions. The INMO Liam Doran, pins the simple, but vital, message that acknowledges the leadership provided on General Secretary, INMO
EDITORIAL
Editor: Alison Moore Assistant Editor: Gillian Tsoi Production Editor: Kennas Fitzsimons Sub-Editor: Sharon Murphy Designer: Paula Quigley Editor-in-Chief: Liam Doran
ADVERTISING MANAGER Leon Ellison INMO Editorial Board: (ISSN: 2009-4264) Claire Mahon, president; Geraldine Talty, first Volume 22 Number 4 PUBLISHER Geraldine Meagan vice-president; James Geoghegan, second May 2014 vice president; Ann Burke; Eileen Kelly; Martin WIN – World of Irish Nursing & Midwifery, McCullough; David O’Brien, Allison O’Connell EDITORIAL & ADVERTISING ENQUIRIES: is published in conjunction with the WIN, Irish Nurses and Midwives Organisation by INMO Journal Co-ordinator: Ann Keating, MedMedia Publications, MedMedia Group, Specialists in Healthcare Email: [email protected] 25 Adelaide Street, Publishing & Design. INMO correspondence to: Dun Laoghaire, Irish Nurses and Midwives Organisation, Co Dublin. Whitworth Building, Tel: 01-280 3967 North Brunswick Street, Dublin 7. Fax: 01-280 7076 Tel: 01-664 0600 Email: [email protected] Fax: 01-661 0466 Website: www.medmedia.ie Email: [email protected] Website: www.inmo.ie
WIN May 2014 Vol 22 Iss 4 5 News
Executive Council 2014 - 2016
Management
• Helen Butler, Director of Nursing, St Luke’s Hospital, Kilkenny • Margaret Frahill, CNM3, Mercy University Hospital, Cork • Claire Mahon, CNM3, Waterford Regional Hospital, Co Waterford
Clinical
• Anne Burke, CNM2, University Hospital, Galway • Ailish Byrne, Staff Nurse, Muiriosa Foundation, Monasterevin, Co Kildare • Moira Craig, Staff Nurse, Beaumont Hospital, Dublin 9 • Theresa Dixon, CNM2, Naas General Hospital, Co Kildare • Karen Eccles, Staff Nurse, Cavan General Hospital, Co Cavan • James Geoghegan, Staff Nurse, University Hospital, Galway • Eileen Kelly, Staff Nurse, Sacred Heart Hospital, Roscommon • Eileen Lawrence, Staff Nurse, Baltinglass District Hospital, Co Wicklow • Mary Leahy, Public Health Nurse, Doughiska Primary Care, Galway • Martin McCullough, Staff Nurse, Sligo General Hospital, Co Sligo • Deirdre Munro, Staff Midwife, University Hospital, Galway • David O’Brien, Staff Nurse, South Infirmary-Victoria Hospital, Cork • Bridget O’Donnell, Staff Nurse, University Hospital, Limerick • Catherine Sheridan, Staff Nurse, Paediatrics, University Hospital, Galway • Geraldine Talty, CNM2, Midland Regional Hospital, Tullamore, Co Offaly • Mary Walsh, Staff Nurse, Sligo General Hospital, Co Sligo
Education
• Martina Harkin-Kelly, Specialist Co-ordinator/Nurse Educator, CN/ME, Sligo/Leitrim & West Cavan, New Grange, Grange, Co Sligo (Category A) • Sinead Maher, Clinical Placement Co-ordinator, AMNCH, Tallaght, Dublin (Category B)
Undergraduate Student
• Darren O’Cearruill, Dublin City University, Dublin 9/Children’s University Hospital, Temple Street, Dublin
6 WIN May 2014 Vol 22 Iss 4 Election Count: Liam Doran, INMO general secretary, pictured at the count of the Organisation’s Executive Council elections 2014 at INMO headquarters recently
Executive Council for 2014-2016 elected Candidates declared for officer elections Following the recent election, president, first vice president/ • Geraldine Talty, CNM2, Nurse, Doughiska Primary the INMO Executive Council, for honorary treasurer and sec- Midland Regional Hospital, Care, Galway the period 2014-2016, has been ond vice president will take Tullamore, Co Offaly • David O’Brien, Staff Nurse, elected (see page opposite). place at 2.15pm on Friday, Office of first vice president/ South Infirmary-Victoria The new Executive Council May 9, 2014 and all official del- honorary treasurer Hospital, Cork will officially take up office fol- egates to annual conference • James Geoghegan, staff Commenting on the elec- lowing the close of business at will have a vote. nurse, University Hospital, tion results, INMO general the forthcoming annual del- There are a total of six can- Galway secretary, Liam Doran said: egate conference in Kilkenny, didates standing for the three • Geraldine Talty, CNM2, Mid- “The Organisation would and will meet for the first time officer positions. Those stand- land Regional Hospital, like to thank and congratu- in June. ing for each position are as Tullamore, Co Offaly late all the candidates and The election of new officers follows: Office of second vice those elected to the new to lead the incoming Execu- Office of president president Executive Council and we tive Council will take place • Claire Mahon, CNM3, • Moira Craig, Staff Nurse, look forward to working during annual conference. Waterford Regional Hospital, Beaumont Hospital, Dublin 9 with them in the months and The election for the offices of Co Waterford • Mary Leahy, Public Health years ahead.”
WIN May 2014 Vol 22 Iss 4 7 News
Roll out of Haddington Road continues The government has the interpretation of the sick of a 39-hour week on the the majority, option 1 above is responded to a request by the pay scheme in respect of the rate of pay the cheapest option: half the ICTU Public Services Commit- staff rostered to work on shift. c) Payment for a period post most recent increment (net tee to extend the ‘grace’ period The Union dispute manage- qualification pre-registra- value). under the Haddington Road ment’s interpretation of a sick tion (approximately six Moratorium Agreement (HRA) to the end day for those employees whose weeks). The INMO has, over a long of June 2015. rostered day exceeds the norm A conciliation conference period of time, requested During the grace period, (7.8 hours). It sought implemen- was held on April 2, 2014 at the lifting of the moratorium the reduction in pay for those tation of the provisions of sick the LRC in respect of these on recruitment for nursing earning over €65,000, and any pay as detailed in Department matters. A resolution was not and midwifery grades. Unfor- deferral of increment progres- of Health Circular 10/71, which arrived at and an adjourn- tunately, this has not been sion, will be disregarded for only makes reference to ‘days’. ment for five weeks has been conceded by the HSE and the pension purposes. Management stated its agreed, at which time the par- moratorium remains in place. Sick leave changes practice with regard to sick ties will reconvene at the LRC. According to HSE figures, Sick leave changes have leave entitlement is to allo- Incremental adjustment at there are 5,100 whole time been introduced for all public cate a bank of hours based on maximum of scale equivalents, less nurses/mid- servants. The government has the norm ie. a 7.8-hour day. With regards to the incre- wives, working in 2014 than in introduced legislation, which For employees whose roster mental adjustment for those 2009. confirms the changes and the exceeds 7.8 hours, the number at the maximum rate of the This matter was referred as a new sick leave scheme was of hours rostered is deducted pay scale, the HSE has now dispute to the LRC and a con- implemented on April 1, 2014. from the banked hours when confirmed the following: ciliation conference was held Any members who did not they are out sick. In addition to the three on March 7. A further concili- attend the INMO information The Court has considered options, previously available ation conference was held on meetings should familiarise the submissions of both par- under the Haddington Road March 20, at which a resolu- themselves with the changes, ties and Department of Health Agreement, which are: tion was not achieved. by looking at the explanatory Circular 10/71 and the more 1. Half the most recent incre- The INMO argues that the bulletins on the INMO website recent 020/2013. The Court is of ment (net value) reduction in nursing numbers (www.inmo.ie). the view that sick pay should be 2. Six annual leave days over resulting from the morato- It is extremely important granted in accordance with the the lifetime of the HRA rium is unsustainable. Clearly, that members contact their Department of Health Circulars 3. The monetary value of the this has impacted on the human resources department and consistent with those Cir- six days annual leave health service and the abil- to have their current sick leave culars, a day’s absence should an additional facility to take ity of nurses and midwives to record confirmed. be regarded as an employee’s unpaid leave is available provide a safe level of care to Sick leave is calculated on rostered working day. There- to employees of the health patients. The INMO contends the basis of the previous four fore the Court does not accept service. that it is also inefficient from years (rolling backwards) – that the practice engaged in by The HSE stipulate that this a cost perspective, as the HSE members must establish the the employer is consistent with unpaid leave request must is now engaging the service of amount of sick leave they have those circulars. have been lodged after July in excess of 700 agency nurses taken since April 2010 and The Court so recommends.” 1, 2013 and excludes unpaid and midwives per week. maintain a personal record to This important clarification leave sanctioned under statu- While these facts are not ensure they receive the cor- is welcomed by the INMO. tory entitlement (eg. maternity disputed, a resolution was not rect entitlement, if it is ever Student nurse issues – LRC and parental leave). Leave aris- arrived at and the HSE sought required. The INMO continues to ing from a career break is also an adjournment for five weeks, Sick leave is measured in argue matters relating to stu- excluded. which has been granted. days, not hours. Some employ- dent nurse pay and conditions. INMO members should The parties are to reconvene ers continue to insist that it As there was no agreement consider all options. However, in due course at the LRC to is recorded in hours and the reached from direct discus- unpaid leave in the majority continue dealing with these INMO challenged this in the sions with the HSE, three issues of cases is likely to be the most issues. Labour Court in March. were referred to the Labour expensive and it will reduce Members will be advised of The Court confirmed the Relations Commission (LRC). pensionable service by that any further clarifications on INMO interpretation as being These issues are: number of days. The original HRA matters, and updated in correct. The extract from rec- a) Application of incremental three options have no pension relation to matters in proce- ommendation no. LCR20731 credit for the 36-week clini- implications. dure, in due course. (March 28, 2014) reads: cal placement in the final Nurses and midwives on the – Phil Ní Sheaghdha, “Recommendation – The year maximum of their respective Director of industrial issue before the Court concerns b) Effects of the introduction pay scale are advised that, for relations, INMO
8 WIN May 2014 Vol 22 Iss 4 News
INMO ADC set for Newpark Hotel, Kilkenny The INMO will hold its 95th Delegates voting at last year’s ADC Annual Delegate Conference in the Main Ballroom of the Newpark Hotel, Kilkenny on May 7-9. The conference will once again see more than 360 delegates, from the Organisa- tion’s branches and sections, gather to discuss and debate nearly 60 motions. The text of the motions submitted for debate can be viewed on the INMO website, www.inmo.ie, together with full details of the conference agenda. The theme for this year’s ADC is ‘SAFE staffing = safe care = safe PATIENTS’. levels, including a debate on at which the following awards Liam Doran said: “The out- The conference will kick Group 2 Professional Motion will be presented: come of the debates over the off with a press conference No 1. Ms Judith Kiedja, acting • Gobnait O’Connell Award three days will set the INMO’s on Wednesday, May 7 at general secretary, New South • Preceptor of the Year Award agenda for the coming year 12.15pm. Following a debate Wales Nursing and Midwifery • CJ Coleman Research Award. and give renewed direction on motions, commencing at Association will address del- Minister for Health, Dr James with regard to how we utilise 3pm, Dr Siobhan O’Halloran, egates on her Association’s Reilly will address the confer- the Organisation’s resources chief nursing officer at the successful 1:4 nurse to patient ence at 12.30pm on Friday, to protect members’ practice, Department of Health will ratio campaign. May 9. registration and employment give a keynote address at There will be a review of the Election of the president, while maintaining their 5.30pm. year from 12 noon to 12.15pm. first and second vice presi- income, and terms and condi- In addition to the debate INMO president, Claire Mahon dents will take place at 2.15 on tions of employment. on the motions, time will be will give her address at Friday (see page 7 for details of Mr Doran concluded: “The set aside on Thursday, May 12.15pm. candidates). three days will also offer del- 8 (11am – 12.15pm) for the As well as the business of The conference will close egates time for relaxation and launch of the INMO’s staff- the conference, there will with a gala dinner on the networking, which are always ing campaign to secure be an awards dinner on the evening of Friday, May 9. vital aspects of our annual get minimum/mandatory staffing evening of Thursday, May 8, INMO general secretary, together.” Extra staff secured for Waterford ED following LRC hearing Additional Nursing staff Agreement was also reached time equivalent permanent tal. The INMO wholeheartedly have been secured for Water- that hospital management nursing posts to be allocated welcomes this positive LRC ford Regional Hospital’s ED would engage immediately to the ED were to address the outcome, and fully acknowl- following a Labour Relations with the HSE’s National Recruit- staffing deficits in Phase 1 edges the contribution of all Commission (LRC) Hearing. ment Service to ensure of the new department only, our members working in the The INMO had referred a appointments to these new and that “further negotiations service to this outcome, both dispute on staffing levels in Nursing posts are made from will be required in the con- in the emergency department the emergency department of the relevant panel as soon as text of the proposed opening itself and in the senior nurse Waterford Regional Hospital possible. In this regard, Water- of Phase 2” of the new emer- management team. to the LRC. A second Concilia- ford Regional Hospital already gency department. “We look forward to speedy tion Conference on this dispute has a panel of nurses avail- Speaking on the issue, IRO implementation of the terms was held on April 10, 2014, and able to it, arising from the most Liz Curran said: “The INMO are of the LRC agreement, which agreement was reached to allo- recent recruitment campaign very pleased to have secured will go some way to ensur- cate an additional six and a half conducted by the Hospital in these additional six and a half ing that the workload on our permanent staff nurse posts to January 2014. WTE nursing posts for Phase 1 members working in the emer- Phase 1 of the new department Finally, it was agreed that the of the emergency department gency department is reduced,” as soon as possible. additional six and a half whole in Waterford Regional Hospi- said Ms Curran.
WIN May 2014 Vol 22 Iss 4 11
Clinical Nurse/Midwifery Managers Section Safe Practice
Saturday, June 14, 2014 INMO Head Office, Whitworth Building, North Brunswick Street, Dublin 7.
Tools for Safe Practice, including Clinical Risk Workshop, followed by a short section meeting. Booking is essential. There is no cost to attend. To secure your place email: [email protected] including your mobile telephone number and work location
INMO_SafePractice_Nurse_April14.indd 1 21/03/2014 10:18 News
Revised pay rates address some imbalance New entrant direct entry grades, including the grade of staff Applicable to direct entry grade of staff nurse/staff midwife (effective from Nov 1, 2013) nurse/midwife, who entered the Salary Salary scale New entrant New/revised Salary public service on, or after, Janu- scale (December 31, 2010) salary scale salary scale difference ary 1, 2011 have been subject point (January 1, 2011) (November 1, 2013) to a reduction of 10% in pay 1 €30,234 €27,211 €27,211 €0 rates and allowances. This has 2 €31,710 €28,539 €29,205 €666 created an imbalance between 3 €33,189 €29,870 €30,234 €364 those who entered the public 4 €34,666 €31,199 €31,710 €511 service since 2011 and those € € € € who entered before that date. 5 36,137 32,523 33,189 666 During the Haddington 6 €37,408 €33,667 €34,666 €999 Road negotiations the INMO 7 €38,683 €34,814 €36,137 €1,323 and other public sector unions 8 €39,952 €35,956 €37,408 €1,452 were successful in securing 9 €41,222 €37,100 €38,683 €1,583 agreement from employers to € € € € address the imbalance created 10 42,469 38,222 39,952 1,730 by the reduced pay rates. New/ 11 €41,222 revised salary scales for direct 12 €42,469 entry grades, including the staff LSI €43,800 €39,420 €43,800 €4,380 nurse/midwife grade, have now been introduced and are effec- midwives who were subject being paid at less than time at office. Contact: Catherine Hop- tive from November 1, 2013. to the 2011 reduced pay rates any point of the scale. kins or Kylie Matterson, Tel: 01 The revised scales effectively will be assimilated onto the Further information is availa- 6640610/19; email: catherine@ merge the 2010 and the new new/revised salary scale from ble from the INMO information inmo.ie or [email protected] entrant 2011 salary scales and November 1, 2013. will allow the 2011 new entrants Revised allowances to progress to the same maxi- All fixed-amount allowances, Survey mum as their 2010 colleagues. including the location, special- The table above sets out the: ist qualification allowances and The Ongoing Maintenance of • Staff nurse/midwife salary theatre on-call allowances pay- scale as at December 31, 2010 able to new entrant staff nurses/ Competence • New entrant salary scale midwives, were also reduced in Nursing Practice: effective from January 1, 2011 from January 1, 2011. These will • New/revised salary scale be restored and paid at 2010 Your Thoughts and Opinions effective from November 1, 2013 rates with effect from Novem- Dear registered general nurse, • Salary difference between ber 1, 2013 – an increase of 10%. 2011 salary scale and 2013 Overtime You are invited to participate in an online survey of registered general new/revised salary scale. With effect from November nurses working in Ireland. Application 1, 2013, overtime for those on The aim of this study is to establish what are the opinions and perceptions The new pay scale will apply salaries of up to €35,000 (inclu- of registered general nurses on the roles/responsibilities of the nurse, to existing staff nurses/mid- sive of allowances in the nature their employer and regulatory body in the maintenance of the nurse’s wives currently on the 2010 of pay) will be paid as follows: professional competence. salary scale, those currently • Staff nurses/midwives on the The survey can be accessed at: www.surveymonkey.com/s/STP6933 on the reduced 2011 scale first and second incremental You can also access the survey via the INMO website: www.inmo.ie and new recruits. However, point will be paid overtime at it will not vary or alter the the first point of the merged The closing date for accessing this survey is Monday, May 12, 2014. pay rates of staff nurses/mid- scale at time and a half The ongoing maintenance of competence in nursing practice is of the wives appointed on, or before, • Staff nurses/midwives on or utmost importance for the safeguarding of public confidence in the December 31, 2010, or those above the third incremental provision of health services. Your opinions and perceptions are extremely who were appointed after this point will be paid overtime important on this topic area. date who were not subject to at the third incremental point Your participation is greatly appreciated and valued by the research team. the reduced pay rates (ie. those of the merged scale at time who were not new entrants to and a half. This formula will Elizabeth Heffernan, Doctorate of the public health service). not apply where this provi- Nursing Research Student and New entrant staff nurses/ sion would result in overtime Professor Josephine Hegarty, School of Nursing and Midwifery, University College Cork News
ICTU plans a new way for better times Dublin’s Mansion House – a historic venue that housed the first Dáil Eireann – was the venue for the recent Economic Conference of the Irish Con- gress of Trade Union (ICTU) which was held in April. Speakers at the con- ference included: Reiner Hoffmann, president desig- nate of Germany’s largest trade union confederation DGB; Sean O’Riain, professor of sociology at NUI Maynooth;
David Jacobson, emeritus pro- Pictured at the recent ICTU Economic Conference were (l-r): Dave Hughes, INMO deputy general secretary; Joseph Taaffe, fourth-year fessor of economics at DCU; work experience student; John Douglas, ICTU president and mandate general secretary; Karen McCann, INMO IT; Colette Mullin, INMO and Joan Burton, Minister of information and research executive; and Albert Murphy, INMO industrial relations officer Social Protection and deputy in fossil fuel consumption, wealth creation in Europe. who promoted the idea that leader of the Labour Party. designing low emission cities, Minister Joan Burton, the state could not create jobs The main response to the building sustainable indus- addressing the fact that up were possessed by a form of global economic crisis and tries and services, modernising to 50% youth unemployment ‘zombie thinking’. She added the European impact of it, training and education, spend- exists across Europe, told del- that a jobs guarantee would promoted at the conference, ing more on research and the egates that she had been a have to be underpinned by has been developed by the development of transport and strong advocate and was a EU states being prepared to German trade union confed- efficient public services. great supporter of the youth directly employ unemployed eration DGB. Funding for this would guarantee, which requires EU persons. At the conference, Reiner come through a new Euro- States to provide a training This was a very significant Hoffman blamed the deregu- pean Future Fund (EFF). The place or a job to the young statement from a government lation of markets as the root EFF would issue interest bear- unemployed after a specified minister and is the first occa- cause behind the global finan- ing bonds like companies or period of time. sion since they took power cial crisis. He advocated that governments which would Ms Burton went on to state that any government minister trade unions across Europe provide investors with strong that she hoped this would has suggested direct employ- must lobby their politicians and secure investment oppor- ultimately develop into a ment into State organisations. for a better social EU and an tunities and would make job guarantee for all, that The conference finished abandonment of the current Europe a better place to live. would see all unemployed with a talk by Tom Healy, over-reliance on markets and A once-off wealth levy of 3% persons being offered an head of the Nevin Economic austerity programmes. on all private assets in excess employment opportunity or Research Institute. He pre- DGB is essentially calling of €500,000 for single people a training opportunity before sented the figures released for a new martial plan similar and €1 million for married they become long-term from the ESRI, which predicted to the one that rebuilt Europe couples and a financial trans- unemployed. optimistic growth for the Irish in 1945. It believes that this action tax of 0.1% could raise She said that her depart- economy. He provided cau- would create a community of up to €320 billion according ment was no longer just the tion about these figures and prosperous democracies as to DGB who estimate that department for assisting peo- expressed his serious concern the original one did and has there is €27 billion in cash ple who were unemployed at the fact that government formed the basis for a half cen- assets in western Europe and others who were depend- ministers were talking about tury of peaceful growth and that is increasingly pursuing ant on the welfare state, but it tax cuts with the minor the European Union. a shrinking range of secure also assisted 7,000 employers improvements that have The fully costed plan, with and profitable investment in terms of making it possible occurred in the economy. an accompanying revenue- opportunities. for them to employ people. Mr Healy also said that such gathering exercise to fund it, Mr Hoffman said that the She said a range of incen- a policy would be disastrous was detailed by Mr Hoffmann underwriting of the banks tives were available for small and that whatever recov- and well received by the across Europe has led to a situ- employers, many of whom she ery already achieved may be conference delegation. The ation where the real economy described as being afraid to extremely fragile. strategy would see increas- is being bled dry by the mar- employ. - Dave Hughes, ing investment in sustainable ket economy, which itself is Ms Burton clearly stated INMO deputy general power generation, reductions making no return to genuine that she believed that those secretary
14 WIN May 2014 Vol 22 Iss 4 News
UHI: Public consultation period opens Dave Hughes explains the basics of the government’s health insurance proposal
On April 2, 2014 the Minis- The State, he said, will have a validity of the financing of the ter for Health, Dr James Reilly, continued strong role and the plan. launched the government’s split between the services pro- The Minister and his depart- universal health insurance vided directly by the State and ment have said that the (UHI) plan and opened a period those through the new pur- average insurance premium of consultation with the public chasing arrangement has yet currently paid is around E960 in relation to it. to be determined. This division per annum for a single adult The plan, which is a commit- will be described as ‘baskets of and if the universal health ment under the Programme c a r e ’. insurance plan were intro- for Government, aims to Under the model of UHI for duced in 2014 (which it will provide a single-tier health Ireland, every member of the not be) the cost would not be system which will be delivered population will purchase a more than that. The expecta- Dave Hughes, INMO deputy general based on medical need. universal health insurance pol- secretary tion is that a full UHI system The Minister said that the icy from their preferred insurer. will be introduced by 2019. HSE will cease to exist and This policy will provide cover commissioning agency and it Critics have suggested that a purchaser provider split for a comprehensive package will be means tested. Parents those countries, like the Neth- will take its place. This will be of health care services. There will be required to provide erlands, who have tried this underpinned by a money fol- will no longer be private and cover for their children as part system are now finding their lows the patient financing public care and equal access of their own UHI. healthcare system is more system. will be based solely on need. The plan is available on the expensive. Others question The purchasing side of the A system of financial sup- INMO website and the health the wisdom of competing UHI will be built around a ports is proposed to ensure service unions are currently insurance companies in a sys- system of competing insur- affordability by the paying preparing a joint response to tem that is community rated ers, including a public option. or subsidising of UHI premi- the announcement. and the potentially high Everyone, Dr Reilly said, will ums for all those who qualify. Initial reaction to the policy costs of the purchaser model have a choice of insurer and The financial support mecha- has been mixed with many suggested. that under the policy all public nism will be managed by the people welcoming the idea of - Dave Hughes, hospitals will continue to be national insurance fund, which universal access on the basis INMO deputy general publicly owned. will be part of the healthcare of need but questioning the secretary Conference specialists pay visit to INMO HQ Join the INMO voices The INMO is hoping to form a nurse and midwife choir. Male and female nurses and midwives who are existing members of choirs or who can sing in a choir are invited to participate. The initial objective is to form a choir with a view to their first perfor- mance being at the formal opening of the Richmond Conference and Events Centre. Those interested should email Dave Hughes, deputy Pictured with Elizabeth Adams, INMO director of professional development (left), were: Daniel Halpin, international sales manager at general secretary: david@ Conference Partners and Keelin Fagan, sales director at Conference Partners. Conference Partners is Ireland’s leading professional con- inmo.ie, inserting ‘INMO ference organiser and specialises in working with Ireland’s best academics and practitioners in attracting international scientific and medical conferences to Ireland Choir’ in the subject line.
WIN May 2014 Vol 22 Iss 4 17 News
Successful transfer of Cork eye theatre The INMO engaged in exten- Section 60(3) of the Health Act the members that they were sive negotiations in recent 2004, wherein, the relocation facilitated in making the key months with the management could not result in less favour- decision whether to go to of Cork University Hospital able terms of employment. SIVUH or stay at CUH. (CUH) to support the volun- The agreement provides for: “The INMO was keen to tary transfer of the 5A ward • Right of return to the HSE for ensure that the entire move and eye theatre to South up to two years was predicated on a voluntary Infirmary-Victoria University • Preservation of salary reduc- basis so as to keep staff moti- Hospital (SIVUH) in Cork. tion for union subs vated and supported. The relocation took place • Preservation of an efficient “Both management teams on April 7 and was proposed theatre roster and theatre and the INMO worked hard under the regional umbrella on-call arrangements to do their best for the nurses of reconfiguration. The move • Financial assistance with car Patsy Doyle, INMO IRO and will review progress in the was complicated because park entry at SIVUH months ahead to ensure that it involved two employ- • A minimum of two-year months to facilitate SIVUH the agreement is protected by ers, a State hospital (CUH), a tenure in the ophthalmic recruitment the beneficiaries, who in this voluntary hospital and a lim- department at SIVUH • Preservation of salary, paid case have made serious sacri- ited company (SIVUH). This • Payment of pension in the twice monthly fices to relocate their working necessitated a revision of the same timeframe as the • Preservation of efficient start lives to ensure expert continu- terms of agreement signed HSE times for CNM2 group ance of elective ophthalmics in December 2011, which • Facilitation of clinical areas of • Any loss of earnings identi- in Cork. “ guided the successful reloca- preference for those staying fied by April 7, 2015, and PSA Ms Doyle concluded: “I give tion of orthopaedic services at CUH (work in progress) formula would apply. particular thanks to Fiona from the HSE to SIVUH. This • Provision for temporary Speaking on the issue, Patsy Landers, CNM2, Jo Hourigan, agreement served to protect secondment to SIVUH Doyle, INMO industrial rela- CNM2, Colette Mullin, BL, and the contractual interests of with the right to return to tions officer, said: “It was of all of the INMO reps and mem- the transferring nurses under a preferred area within six paramount importance to bers at CUH.” Nazareth House threatens to break pay rate agreement INMO members at Nazareth areth House management and The management has not team and making it more House in Mallow are shocked INMO members at different heard the INMO’s proposals cohesive. that the long-standing times and has been mandated that: At present, Nazereth House agreement to uphold pub- to object to and reject any of • Consideration be given to management is paying all of lic sector pay rates is under the proposals on: selling Nazareth House assets its external bills but placing threat again. • 12.5% pay cut • Consideration for further threats of inability to pay to In 2010, the care facility • Cessation of location expansion into higher concerned staff without any entered into an agreement allowance income generation beds valid justification. with the INMO to pay Depart- • Reduction in public holiday • Consideration to upward The INMO will continue to ment of Health and Children premiums alignment in funding from engage with management rates, but is now seeking to • Reduction in sick leave and Hammersmith as Nazareth but unless Nazareth House break this agreement, citing annual leave House is a subsidiary of this accepts and honours the fair deals insufficient “cost of • Reduction in direct care economic entity LRC agreed rates, a dispute is care” as the catalyst. hours from 4.5 to 3.5 without • Consideration of increas- expected. The INMO has met with Naz- any risk assessment. ing the direct care nursing - Patsy Doyle, INMO IRO Labour Court finds in favour of night nurses upgrade appeal The Labour Court has found uphold a commitment made in and the Labour Court recom- Doyle, INMO industrial rela- in favour of two night nurse December 2011 to upgrade the mended that, through the tions officer, said: “This claim managers at Community nurse managers to CNM3 grade vehicle of national talks on the crystallised the centrality of Nursing Units in Cork, on the in return for taking on the night finalisation of community hos- comprehensive night manage- upgrading of their positions governance for 140 patients at pital governance, both nurse ment in community hospital to clinical nurse manager 3 Farranlea and Heather House managers are to access CNM3 settings. The IMNO will work to (CNM3) grade. CNUs. grade within 12 months. implement the Court’s recom- The HSE had refused to This decision was challenged Speaking on the matter, Patsy mendation as soon as possible.”
18 WIN May 2014 Vol 22 Iss 4 News
UHL set to offer members education support The INMO and management University of Limerick from critical care courses are also at the University Hospital Lim- 2015. being explored for September erick (UHL) have engaged in The hospital has also 2015 in conjunction with the a joint working group, with invested in stress manage- University of Limerick. the support of the Nursing ment workshops for nurses There are also intensive Midwifery Planning and Devel- working in the emergency recruitment campaigns run- opment Unit, that is aiming to department. An external facili- ning parallel to these initiatives deliver a suite of educational tator, Barbara Dewar from the to support and stabilise the supports for nurses at the UK, will host workshops for nursing workforce at the hos- hospital. nurses on the delivery of com- pital, which suffered significant A particular emphasis is passionate care. nursing deficits in the past five being placed on the emer- Additionally, to support years as a result of the blunt gency department with the wider hospital group, it Mary Fogarty, INMO IRO moratorium in the HSE. postgraduate educational is expected that a ‘Return to The Organisation is continu- opportunities in emergency nursing’ course will be under- ment within the hospital ing to engage with hospital nursing being made available taken at UHL in September group. management on all of these for members at NUI Galway with participants committing Postgraduate general nurse issues. for September 2014 and in the to some post-course employ- and postgraduate theatre and - Mary Fogarty, INMO IRO Court confirms sick day entitlement for Limerick members The Labour Court has upheld days/nights would be counted roster exceeds 7.8 hours, the engaged in by the employer the INMO’s position on sick as a day and a half of sick number of hours rostered is was consistent with national leave entitlements within the leave, which would result in a deducted from the banked circulars. In light of the recent Brothers of Charity Services, loss of seven self-certified sick hours when they are out sick. changes to the sick pay Limerick. days to be replaced with only The Court, however, found that scheme this is a significant Management in this service 4.5 self-certified sick days over sick pay should be granted in clarification from the Labour had converted sick leave enti- a rolling two-year period. accordance with the Depart- Court and all nurses and local tlements from days to hours Management stated to the ment of Health circulars and INMO representatives who without agreement and con- court that its practice with consistent with those circu- are employed in the public trary to both local policy and regard to sick leave entitle- lars, a day’s absence should be sector should ensure that national agreements and cir- ment is to allocate a bank of regarded as an employee’s ros- the correct sick leave enti- culars. This resulted in nurses hours based on the norm (ie. a tered working day. tlements are applied in their having a reduced number of 7.8-hour day). Therefore, the Court did workplace. self-certified sick days as long For employees whose daily not accept that the practice - Mary Fogarty, INMO IRO In Brief s M id-west community nursing services: INMO members working in the mid-west community nursing services have agreed to engage with management to review criteria for planned essential services and the resource requirements in the coming weeks. This review of the service will be done via a local working group. Management made a proposal to the INMO in 2013 to introduce a five-over-seven roster for public health nurses (ie. to be rostered working at weekends to deliver planned essential services). However, the INMO contended that this would require an additional whole time equivalent of approximately 22.6 nurses. In addition to this, the current extensive crossover arrangements that are in place in the service would need extra sup- port. Management has since advised the INMO that it wishes to prioritise, as part of planned essential services at weekends, the delivery of 48-hour visits to mothers and babies discharged from maternity hospital and metabolic screening. s St Joseph’s Hospital, Ennis: As a result of the INMO’s engagement with management at St Joseph’s Hospital in Ennis to review rosters, it has been identified that staffing levels there have fallen below a level that would ensure safe care and the numbers necessary to keep all beds operational. Up to 20 beds are currently closed at the hospital to allow for the staffing deficits. There- fore, the review of rosters that was proposed by the HSE cannot proceed until an analysis of staff to patient ratios and skill mix requirements for continuing care, rehabilitation and short stay, has been completed. Staffing needs are currently under review by the HSE for presentation to the INMO shortly. – Mary Fogarty, INMO IRO
WIN May 2014 Vol 22 Iss 4 19 Section News
Donegal spring break for Retired Section Members of the INMO Retired Section recently enjoyed a trip to Donegal, where they stayed in the Mount Errigal Hotel in Letterkenny. The trip, which took place in March, had a packed sched- ule which included visits to many historical and interesting places. The Section members went on an excursion to the graveyard where Agnes Jones, colleague and friend of Flor- ence Nightingale, was buried and travelled by coach to the tip of Malin Head on a day that was incredibly warm and sunny. The Retired Section of the INMO pictured at Malin Head while on their recent Spring break in County Donegal The beautiful weather allowed them to enjoy the magnificent The castle remains beautifully ering above them. The tour educational tour of the Ulster scenery at its most splendid. maintained, as are the gardens passed through the city and American Folk Park. The group also went on and grounds. by its beautiful Peace Monu- Those on the trip extend a tour of Glenveagh Castle, A memorable visit was paid ment before visiting Doagh sincere thanks to Myra Gara- which was built around 1870 to the city of Derry where the Famine Village, which tells the han, who organised the and was privately owned until group took part in a tour that story from the famine of the hugely successful break, and Henry Mcllhenny presented commenced on the banks of 1840s to the present time. The the coach driver on the trip, the building and its gardens the Foyle river with St Columb’s Section also visited Omagh and Brendan, who also deserves a to the Irish nation in 1981. Cathedral, built in 1633, tow- had an amazing historical and special mention. Changes introduced to GP nurses’ indemnity insurance Changes were made to the A panel consisting of GP nurse as a registered mid- private employment and often INMO’s indemnity insurance industrial relations, legal wife, and scope of practice and work in isolation without peer for general practice (GP) and insurance experts gave accountability issues in gen- support and guidance. The nurses on March 1. In addition, short presentations on eral practice. importance of continual clini- the current general contin- why the insurance changes Difficulties facing the GP cal professional development gency policy of indemnity was were made. They also spoke nurse in the development cannot be underestimated, replaced with a new legal about the medical and ethi- of policies, procedures and and the committee urges GP defence policy. cal aspects of practice and guidelines were highlighted nurses to attend section meet- The changes in the insur- the importance of safe prac- at the information session. ings and communicate with ance had varying effects on tice. The panel also included: The GP Nurse Section com- other GP nurses. GP nurses and exposed issues Claire Mahon, INMO presi- mittee was delighted to The next educational day such as the GP nurse clinical dent; Clare Treacy, INMO announce that it will put for- will take place on May 17, contract and the responsibil- director of social policy, regu- ward a motion at the INMO during which a workshop on ity of the employer to provide lation and recruitment; Olwyn ADC this month, that a core ‘Tools for Safe Practice’ will insurance for these nurses, McWeeney, barrister-at-law; committee should be estab- be facilitated. This is free to among other issues. Sharon Brennan, a senior lished to ‘sign off’ documents INMO members. There will also An information session was medical malpractice under- that are developed to guide be a practical session on the held in The Gresham Hotel in writer at WR Berkley; and evidenced-based practice and development of policies, pro- Dublin, at the request of the Nancy Layton-Cook, director that a ‘bank’ system should cedures and guidelines in the GP Nurse Section committee, at CJ Coleman & Co. be established by the GP Sec- afternoon. to guide nurses through the A question and answer ses- tion committee that will share The committee urges GP changes to the insurance. The sion evoked a huge response developed policies, proce- nurses who are still having dif- committee was delighted to from attendants with particu- dures and guidelines with GP ficulties with the transition in welcome David Hughes, INMO lar focus on issues such as nurses. the insurance cover, to make deputy general secretary, who insurance cover for the provi- Practice nurses are vulner- direct contact with the INMO addressed the session. sion of antenatal care by the able by the nature of their at Tel 01-6640600.
20 WIN May 2014 Vol 22 Iss 4 Standing ovations were the order of the day at the Operating Department Nurses annual conference in Limerick in March Pictured below (l-r) were: The ODN Section team and the INMO president: Monica Griffin; Sandra Morton; Liz Waters; Audrey Al-Kaisy; Claire Mahon; Teresa Herity; and Allison O’Connell ODN conference a ‘big hit’ with members “Well done”, “excellent”, “blown challenges that perioperative away”, ”informative” – these nurses face in relation to safe are just a few of the words practice. that were used to describe A talk on GS1 barcoding, speakers at the ODN annual currently being used in St conference in The Strand Hotel James’s Hospital and other in Limerick in late March. departments nationally, pro- The event featured a host vided an interesting snapshot of national and international of the future. GS1 barcoding is speakers such as Brid O’Brien, the new national decontami- who gave a presentation on nation tracking system, which ‘anticipatory vigilance’ –the is set to revolutionise efficien- first nursing theory on what cies in healthcare. way of a draw of all attendees who attend the most Section perioperative nursing is. Poster competition at the conference in Limerick. meetings per year, and Sec- Dr James Clarke, from the UK, The ODN annual conference The registration prize is worth tion officers are exempt from addressed delegates on briefing provides an opportunity for €475. For details about EORNA these costs. Additionally, by and debriefing – two essential perioperative nurses to share 2015, visit www.eorna.eu presenting at, or by submitting parts of the ‘Safe Surgery’ cam- their research findings via the Presentations from the 2014 posters to the event, registra- paign, which are missing from poster competition, which conference are available to tion fees may be waived. the HSE ‘Safe surgery’ policy. remains a strong component view on www.inmo.ie Who’s who Meanwhile, Tracy Coates dis- of the event. This year’s post- ODN Section The ODN Section officers are: cussed the reporting of clinical ers were, once again, of a very Members of the ODN sec- Audrey Al-Kaisy, chairperson; incidents and near misses. high standard. tion are urged to keep their Allison O’Connell, vice chairper- The audience was wowed The winners of the com- contact details up to date with son; and Teresa Herity, national by two Spanish speakers, petition, kindly sponsored by the INMO to ensure that they secretary. The two EORNA rep- Nerea Herreros and Maria Teckno Surgical, were: receive notifications relevant resentatives are Sandra Morton Angeles, who presented their • Theresa Donnelly, acting to the Section. and Liz Waters, who is set to ‘Kirozainbide’ – the result of CNM2 at Sligo General Hospi- The ODN Section is in chair the Scientific Commit- the ‘Teamwork’ project, which tal, for the poster, ‘Two four six existence for 47 years and tee for EORNAC 2015 in Rome. was featured at the European eight, stop and count before continues to be a key player Monica Griffin is a conference Operating Room Nurses Asso- it’s too late’ in the education of periopera- planning committee member ciation (EORNAC) 2012. • Yvonne Claffey, theatre nurse, tive nurses in Ireland. There are and expert support is also pro- The project is about the jour- and Brid O’Brien, lecturer at strong networking links within vided by section development ney undertaken by a group Portiuncula Hospital in Gal- the Section, which meets four officer Jean Carroll, assisted by of perioperative nurses in the way, for the poster, ‘Promoting times a year, twice in Dub- Helen O’Connell. development of a Wiki lan- perioperative normothermia lin and twice regionally. All The ODN Section is also hon- guage-based learning tool for in adult patients’. perioperative nurses are wel- oured to have Caroline Higgins their operating department. All perioperative nurses are come at the meetings and the in the position of president of Angela Branagan and Deirdre invited to submit posters to national conference, which is EORNA, as this shows that Irish Downey presented their find- the ODN annual conference. also open to non-members. perioperative nurses are held in ings on an audit on inadvertent EORNA Attending meetings is free, high esteem abroad. hypothermia in paediatrics, EORNA, of which the INMO and the costs to attend our The next ODN Section meet- which they had presented on a ODN Section is a member, will annual conference are con- ing will be held in INMO HQ at poster at EORNAC 2012. be holding its next congress in siderably reduced thanks to 7pm on June 26. Michelle Russell, an inde- Rome on May 7-10, 2015. company sponsorship. An Audrey Al-Kaisy pendent nurse consultant, Jannie Ruiter won free regis- educational trip is raffled once National chairperson, engaged the audience on the tration to attend the event by a year for those members ODN Section
WIN May 2014 Vol 22 Iss 4 21 Feature ?
This month sees international celebrations of the professions of nursing and midwifery
Nurses worldwide will celebrate Inter- safe staffing. Changing scopes of practice • To develop a global partnership for national Nurses Day on May 12 (the and the influence of new technology have development. anniversary of Florence Nightingale’s also changed the way nurses work.” While there is a nursing shortage in birth), which has the theme: ‘Nurses: A Properly trained, motivated health many countries, including Ireland, simply Force for Change – A vital resource for workers are essential for the health of adding more nurses is not the solution: health’. the world’s population. Equal access to improving the work environment is a key The International Council of Nurses good quality health services cannot be aspect of improving patient safety and (ICN), of which the INMO has been a achieved without an adequate number of the quality of health care. member since 1925, commemorates this appropriately prepared nurses. Because of It is essential that nurses and world important day every year with the circula- this, ICN has chosen to focus on the vital leaders focus on the global nursing work- tion of the International Nurses’ Day (IND) resource that is the nursing workforce for force as a key priority for achieving better Kit. This year’s kit contains educational and this year’s IND theme. health for all. public information materials, to be used Through the IND toolkit, the ICN hopes International Day of the Midwife by nurses around the globe. It includes to inspire nurses to “change the pic- The achievements of midwives a poster image that can be downloaded ture” and demonstrate to governments, worldwide will be acknowledged and for use by individual nurses, associations, employers, and society that nurses are a celebrated on the International Day of health ministries and health institutions. vital resource for health. the Midwife on May 5. The event, which The kit has already been disseminated Nurses are the largest group of health is hosted by the International Confedera- to national nurses’ associations worldwide professionals; they are the closest and tion of Midwives (ICM), will also give the and can be accessed at: http://www.icn. often the only available health work- midwifery profession an opportunity to ch/publications/2014-nurses-a-force- ers to the population, and have a great refocus on the goals that still need to be for-change-a-vital-resource-for-health/ responsibility to improve the health of accomplished. Though mainly planned around May the population and contribute towards To mark International Day of the Mid- 12 each year, IND activities continue for the achievement of the Millennium Devel- wife, the ICM asks the world to focus much of the year and the ICN encourages opment Goals, which relate to pregnant on the role of midwives and midwifery. nurses everywhere to make extended use women and their newborns. . Each year, ICM comes up with a cam- of the kit throughout the year, through There are eight international develop- paign theme to provide a motivating individual action and group activities. ment goals, which were established in call to action for all of us to get involved Judith Shamian, president of the ICN, 2000, to be achieved by 2015 following and champion our work. The aim of the said: “This IND kit is an essential tool to the adoption of the UN Millennium Decla- day is to engage stakeholders across the understanding the bigger picture of ration. They are: world with local activities of midwives the healthcare labour market: the gap • To eradicate extreme poverty and hunger associations as well as a virtual campaign between the supply and demand of • To achieve universal primary education advocating for investment in midwives health workers, the effect of the financial • To promote gender equality and and midwifery globally resulting in the crisis, migration and the working life span empower women wellbeing of mothers and newborns. of nurses. “ • To reduce child mortality rates This year, midwives are encouraged to According to the ICN, the kit “highlights • To improve maternal health incorporate singing or music leading up the importance of workforce planning • To combat HIV/AIDS, malaria and other to the world record of midwives singing and the link to patient safety; how to diseases together at the start of the ICM Triennial measure nurses’ workload and plan for • To ensure environmental sustainability Congress in June.
22 WIN May 2014 Vol 22 Iss 4 International News
Examples of ways in which midwives ciations and can mark the day include: supporters • Organising a concert, singing contest, of midwifery karaoke globally are • Organising a march, run, street parade urged to and rally in a public place develop their • Setting up stalls in a market-place or own key other popular area to publicise mid- activities for wifery services and to offer information the event. and advice The Essence • Holding a meeting, workshop or confer- of Midwifery ence to hear about new developments Care Con- in midwifery and exchange news with ference is other midwives in the region the main • Inviting a government minister, NGO focus for representative or a celebrity to speak or midwifery open an event. celebrations In 2014 the new subtheme “Midwives in Ireland. changing the world one family at a time” It will sends a strong signal that midwives be hosted provide care that changes families, com- by The munities and the world by saving the Coombe lives of mothers and babies. This new Women theme also resonates with the overarch- and In- ing theme that has accompanied IDM for fants the past years: ‘The World Needs Midwives University Now More Than Ever’. Both themes under- Hospital line the importance of midwives and their in part- work on a local as well as global level. It nership with also supports the case that adequately the Nursing educated and resourced professional mid- and Midwifery wives are crucial to achieving Millennium Board of Ireland Development Goals (MDGs) 4&5. Further- (NMBI) and will more, the message that ‘Midwives Save be held on May Lives’ is increasingly relevant as the 2015 1. deadline for realising the MDGs draws The confer- ever closer. ence is being In global terms, maternal mortality organised In rates are high, and neonatal mortality the lead up to rates are also a cause for concern. Infant the Interna- mortality has declined considerably but tional Day of neonatal mortality rates remain high. Too the Midwife. many women in developing countries The NMBI cannot access midwives or any healthcare will hold the professional during pregnancy, birth and first Mid- the postpartum period. wives Week In 2010, the Global Strategy for Wom- to mark the en’s and Children’s Health stated that an recognition, extra 3.5 million healthcare workers were in Ireland, of required to ensure improved health for midwifery as women and their newborns. In 2005, WHO a separate stated that an additional 334,000 midwives profession. would be needed in the years to 2015. The The theme Organization recommends a ratio of one is ‘Promot- midwife for every 175 women. Many would ing Safe argue that such a ratio is inadequate, but Care for some countries, such as Rwanda, have only Mother one midwife per 8,600 births. and Baby’ Each year local midwives, midwives’ asso- and it runs from April 28 to May 2.
WIN May 2014 Vol 22 Iss 4 23 Bulletin Board With INMO director of industrial relations Phil Ní Sheaghdha
Query from member Reply As a job-sharer at the maximum of my scale, how will the Haddington Road Agreement affect my pay and what are the The Haddington Road Agreement, at 2.24, set out that employees on implications of having taken unpaid leave in 2013 and taking the final point on the incremental scale and with salaries between E E unpaid leave in the future? 35,000 and 65,000, inclusive of allowances in the nature of pay, would be required to agree to one of the following: • A total reduction of annual leave entitlement, over the period of the agreement, of six days • A cash deduction from salary of the equivalent amount to the value of the six annual leave days, or: • Half of the most recent increment, whichever is the lesser. Subsequent to the Haddington Road Agreement, the HSE, following negotiations with the trade unions, issued a circular on 18 December 2013 that also allowed the taking of unpaid leave as an option. In this circular it stated: “The taking of unpaid leave is an option, however, this would be the most costly option for employees as deduction will be based on the gross figure for the day’s pay, and considered to be special leave without pay. This should be brought to the attention of any staff member considering this option”. We have sought clarification from the HSE in respect of those that have taken unpaid leave since 2013 and it has been confirmed that this can be offset against this provision if unpaid leave has been taken. You would be required to make a pro rata payment of these provisions because you are a job sharer. In other words, three annual leave days over the lifetime of the agreement or a pro rata of the amount of half of the most recent increment that you received. In other words, you did not receive the full increment because you were on half salary; therefore, a half of what you actually received is what you would pay. As you are probably aware, the annual leave adjustment is a once-off, as is the payment and does not mean a permanent reduction to your annual leave and the lump sum payment is paid once, not each year. I hope this clarifies your question and please feel free to contact us if you have any further questions on this matter.
Query from member I sustained an assault from a patient at work and Reply subsequently needed time off and physiotherapy. My Yes, as previously advised to members, there is a scheme that cov- employer is saying that this is normal sick leave. However, ers physical assaults in the workplace. This scheme allows for pay at a recent meeting on the changes to the new sick leave inclusive of premiums that you would have earned had you not scheme, the INMO presented on the revised Physical been assaulted, to be paid to you. In addition, the period of time Assault at Work Scheme for nurses and midwives. Can you spent absent from work is not considered sick leave. You should please advise if I can seek inclusion in the revised Physical immediately make contact with your employer and request to Assault at Work Scheme for this injury? be included in the revised ‘Physical Assault at Work Scheme’ for nurses and midwives. If this is denied, you have the right of appeal to an Appeals Board and you should seek assistance with the appeal from your local INMO industrial relations officer. I trust this answers your question, but please contact us if you have any further queries on this issue.
You are not alone Counselling, legal advice, domestic assistance and bodily injury cover Free helplines provided by DAS, 365 days a year, 24/7 Tel: 1850 670 407 for counselling or 1850 670 707 for other services See www.inmo.ie for further details Quality & Safety A column by Maureen Flynn Integrated Guidance: A guide to discharge and transfer from hospital
Nine steps in effective discharge and care from hospital to community
This month’s focus is on quality and safety Step 1 (page 15): Step 2 (page 19): Step 3 (page 21): in discharge or transfer from hospital. Begin planning for Establish whether the Develop a treatment plan The practical guide to integrated care is discharge or tranfer service user has simple or within the first 24 hours designed to support healthcare providers before or on complex needs of admission admission to improve their discharge and transfer processes from the acute hospital setting back into the community, and thereby support the delivery of high quality safe Step 6 (page 30): Step 5 (page 28): Step 4 (page 23): care. Inform service users and Set up an estimated Work together to provide length of stay or predicted The National Integrated Care Guid- carers so they make comprehensive service informed decisions date of discharge/transfer user assessment and ance (2014) has been developed by the and choices within 24-48 hours of treatment admission National Integrated Care Advisory Group chaired by Liam Duffy under the auspices of the Quality and Patient Safety Division. It is based on feedback received following Step 7 (page 33): Step 8 (page 34): Step 9 (page 36): extensive national and targeted consul- Review the treatment plan Use a discharge checklist Make decisions to on a daily basis with the 24-48 hours discharge/transfer tation with service providers in both the service user before discharge service users each day acute and community healthcare settings and on review of the HSE Integrated Dis- charge Planning Code of Practice (2008). reconciliation process flow for admission to Clarifying changes and actions required The Integrated Care Guidance (2014) and discharge from acute care; 4) a service to improve outcomes in terms of effective replaces the existing HSE Integrated Dis- user discharge tracking form; 5)criteria discharge and transfer from the hospital charge Planning Code of Practice (2008). for nurses (or health and social care pro- will focus on and drive improvement in What is integrated care fessional/other) to undertake discharge; the organisation. The guidance document It is the ‘processes, methods and tools’ and 6) rapid discharge planning guideline and checklist can be accessed via the of integration that facilitate integrated summary. Quality and Patient Safety Division home care. Integration involves connecting the This guide will support service pro- page at http://www.hse.ie/go/qps healthcare system (acute, community and viders in demonstrating how they are Any feedback on experiences of using primary medical) with other service sys- meeting the National Standards for Safer the resources, and how they might be tems such as long-term care, education or Better Healthcare (NSSBH),2 and the High improved, is most welcome. For further housing services.1 Impact Changes required to Improve Per- information, contact Angela Hughes, The guidance describes nine key steps formance with Unscheduled Care.3 National Integrated Care Guidance lead in effective discharge and transfer of care Opportunity to use the resources at the HSE Quality and Patient Safety Divi- that can facilitate faster, safer discharges This guidance will be of assistance to sion. Email: [email protected] for patients (see graphic). These steps you in reviewing or auditing your ward, Maureen Flynn is the director of nursing (national include identifying whether the person unit or service discharge and transfer lead for quality and safety governance development) has simple or complex discharge needs, practices. To start, you may undertake an at the Office of the Nursing and Midwifery Services Director, Quality and Patient Safety Division HSE setting an expected date of discharge/ assessment using the nine steps for effec- Acknowledgement: The National Integrated Care Guid- transfer and reviewing treatment plan tive discharge and transfer and using the ance has been developed by the National Integrated Care with the person on a daily basis. checklist provided in the document. This Advisory Group under the auspices of the Quality and Patient Safety Division. With thanks to Liam Duffy, chair The Integrated Care Guidance docu- will help to identify strengths, weaknesses and members of the National Integrated Care Advisory ment contains process maps and is and opportunities for improvement. The Group and the many staff, service users and members of the public who made submissions during the develop- supported by: 1) a two-page, nine-step guidance may also be of assistance if you ment of the guidance document. checklist for ease of reference; 2) the prin- are reviewing or developing new forms References on request from [email protected] (Quote ciples of the patient charter; 3) medication for discharge. Flynn, M. WIN 2014; 22(4): 25)
About the HSE Quality and Safety Division: The Quality and Patient Safety (QPS) Division of the Health Service Executive (HSE) was established in January 2011, on the appointment of the National Director, Dr Philip Crowley. The role of the QPS Division is to provide leadership and be a driving force by supporting the statutory and voluntary services of the HSE in providing high Quality and Patient Safety Division quality and safe services to patients their families and members of the public.
WIN May 2014 Vol 22 Iss 4 25 Interview Staff, safety and social supports
HSE director general, Tony O’Brien, doesn’t believe health service staff numbers can be reduced much further. Interview by Niall Hunter
Why does the HSE have such a negative Notwithstanding staff reductions of recent the health service. If the absolute freedom public image? years, do you think there are still too many existed to do so, I would prefer the cleri- It’s negative because from the moment managers and not enough frontline staff? cal and admin staff that we have left to be it was established, every act, sign of omis- The reality is there have been very sig- doing things that directly support patient sion or commission, by every health board nificant reductions in administration staff. care, customer interaction, the medical or health entity that ever existed before, Clerical or management admin actually card scheme, health promotion etc. was immediately labelled as relating to includes a lot of things that aren’t really in Some of our accounts payable func- the HSE. Also, the manner of the HSE’s cre- that category. There is a range of special- tions could potentially be contracted out ation was sub-optimal. It happened very ist staff within that category, for example to other service operators. Obviously in quickly and, with the benefit of hindsight, the staff who check patients into an out- saying that, I would caution that there are too many things were pushed together patient clinic, who would be classified as provisions under the Haddington Road too quickly without enough attention or admin. A whole raft of things, which are Agreement which would stipulate that time to be paid to fundamental issues that really customer-facing, are classified as very specific processes would have to be could have changed the characteristic of management and admin, and many clini- gone through, so I wouldn’t want to give the health service. cal staff will tell me they are suffering from the impression that I am about to out- Such as? a shortage of the appropriate skill mix in source a whole raft of functions without Well, for example, systems. There was this area, which would enable them to do due regard for policy, but these things no time to prepare appropriate integra- their best work. can be done in certain ways. As part of the tion of systems so, even now, the HSE has The HSE has been downsized by volun- overall reform programme I feel it is some- great trouble producing national data on tary exit programmes, but this has been thing we definitely have to look at. a number of things, even basic financial entirely unstructured; a fairly blunt instru- Do you believe there has been a lack of clar- data. ment. Quite a lot of staff have exited under ity to date on future health structures in the The merger of health boards happened these voluntary programmes from areas reform process once the HSE is abolished? under circumstances where it wasn’t pos- which have been development priorities. Are there going to be far too many ‘quangos’ sible for the organisation to ‘delayer’ itself. While some staff may have left from sectors in accompanying universal health insurance? It created additional layers of bureaucracy which they were badly needed, are there areas No, I think in the immediate post-HSE which have taken a long time to reduce, that could actually be downsized further? phase, it’s clear there will be seven hos- and that became quite paralysing for the What I’d want to do is look at those activ- pital groups, and a certain number of organisation. Many people inside it felt ities that we are currently using staff for community health organisations. They will disempowered, unable to do their best that could potentially be provided by other all be commissioned and funded through work, and as a result the high expec- service providers outside the HSE, and a Healthcare Commissioning Agency. Then tations created for the HSE were very then use the staff we do have for things there will be the Department of Health, var- quickly dashed. that need to be provided as a core part of ious regulatory bodies and a new patient
26 WIN May 2014 Vol 22 Iss 4 Interview
safety agency. I think there is a relatively ensured that the ‘floor’ level is also correct It’s a ceiling above which you cannot go. clean diagram of what the entities will be. in terms of the basic numbers of staff that So we are actually recruiting. In the con- There seems to be a plethora of new and you need for each service that you have in text of current reforms I would hope that existing organisations involved. Are we going the totality of services that are necessary arrangements can be made so that the back to the pre-HSE, health board system? to meet the needs of the population. very large numbers of staff, particularly No, I wouldn’t agree. The hospital The numbers that we have had haven’t in the nursing area, who are currently in groups are nothing like health boards. been derived from that type of an exer- agency employment but substantially With the advent of the clinical pro- cise. When you have an arbitrary number working for us at higher cost, that we grammes, with hospital licensing, with of staff that decreases year on year, and could arrive at a situation in which we standards for safer healthcare, it is very is determined by a process that isn’t fully could convert those into regular long- clear what each hospital group has to do connected to need, then it is essentially term temporary staff. and how it should do it, but in terms of a crude process. The ‘grace period’ exit In this way, there would be more sta- how they organise resources within the programme which occurred in early 2012 bility for them, a better employment group there will be more freedom, but led to a 5% downsizing of the HSE pretty situation for them, a lower cost for us, they’re not comparable to health boards. much on a single day. No manager or and likely to increase the quality of care There’s a view, which I would agree with, policy maker was able to sit down and provided through the benefits of consist- that the HSE as a single construct is simply say this is where we need to reduce staff ency. We are now excessively dependent too big to be effective. To move away from numbers. It was a case of ‘put your hand on agencies for highly specialised nursing one thing that’s too big you have to have up and you go’. staff and that’s a particular weakness in several other things that are less big. The net effect of that is that a huge our system. These changes all revolve around universal amount of institutional memory – expe- In light of recent reviews in the wake of health insurance. Do you think UHI is afford- rience and skill sets – was lost from the safety incidents, is it feasible to keep some able and will it be introduced by 2019? organisation. As a result, many units in the smaller maternity units and EDs open? All of these other changes would be organisation, but for the deployment of I think there is a real underlying issue of appropriate whether or not we were temporary staff at great expense, would sustainability. There is a review of maternity heading to UHI. We’re now entering a have ceased to function. As a result of this services and a review of ED services in the period of consultation on what the basket we have seen an increased reliance on Dublin region. There are legitimate ques- of care (of services to be covered under agency personnel which pushes up the tions about how we used the resources UHI) should be. I have never made any cost of labour, introduces instability into available in light of all the evidence about secret of the fact that I am a strong per- the workforce, and all of those things are how to provide the safest most sustainable sonal believer in the principle of universal known to have an adverse impact on the care, and whether that will require changes healthcare, where access is based on need overall quality and cost of the health sys- to the configuration of services such as and not economic means. tem. The government has now put back maternity units and EDs. The only way you can get there is what would have potentially been a fur- It will be very much driven from a qual- either by an NHS-type model or a uni- ther exodus this year, through a further ity perspective. I don’t see it as a way of versal health insurance type model. Both ‘grace period’ early retirement scheme. reducing overall costs. The number of of them appear to be reasonably valid I would not argue for compulsory births we have each year will still have to models. Under either model, the one redundancy but I would be in favour of be provided for. If you are going to have a thing that’s clear is that it’s people of the having a degree of discretion on both smaller number of units, that number will country who are paying for the health- sides, where people can volunteer to leave have to have greater capacity. care, there are just two different routes of but there can be no automatic right to go. Is it inevitable then that some maternity doing it. I’m in no doubt as to the degree Do you think it is feasible for staff numbers units and EDs will, if not close completely, of commitment of the government to in the health service to be reduced any have their roles changed and no longer pro- moving on the road to UHI. further? vide the current level of services? How concerned are you about healthcare I don’t believe that staff numbers in Well, I’m not going to prejudge the safety issues in the context of concerns the health service can be reduced very outcome of the maternity review. By com- about the sustainability of year-on-year cut- much further, if at all. For example, in the parison with some other countries it’s not backs in the health service? maternity area, we are going through an that we have particularly small maternity Given the upward trajectory of demand analysis using a tool called Birthrate Plus services, it’s a question really of whether and the downward trajectory of resources, (to analyse staff ratios) – we will be look- they are sustainable safely, given the rela- there is going to come a time where the ing to do similar things to benchmark tive unattractiveness of certain locations bottom has been reached. Some argue the appropriate staffing and appropriate for staff etc. It’s a whole series of ingredi- that we may have reached that bottom skill mix in different services. There will be ents that need to be examined to ensure already. I would be perhaps more con- variable answers; some services are better we have safe sustainable maternity ser- cerned about the impact of head count staffed than others, some are understaffed. vices. The ED issue is a little more clearcut. limitations on the health sector, for two Do you think that at this stage the recruit- Objectively, for a city the size of Dublin reasons. One is that you can’t really have ment embargo can be eased, particularly in with its current population, the spreading a never-ending downward upper employ- areas such as nursing? out of ED resources , the fact that we have ment ceiling unless you have tested and It’s not an absolute recruitment freeze. so many hospitals seeking to be both elec-
WIN May 2014 Vol 22 Iss 4 27 Interview
‘The HSE has been tive and emergency admission hospitals, downsized by voluntary cards were granted outside of those terms leads to the probable conclusion that there exit programmes, but in the past that haven’t been renewed, is a better way of doing things and that or have been withdrawn. But there have work is ongoing. this has been entirely been no ‘cuts’ to the medical card system After so many treatment scandals, do you unstructured; a fairly per se. The medical card system is costing think the HSE is finally dealing effectively blunt instrument. Quite more and more all the time, so there is no with the maintenance of safety standards cut to the overall level of expenditure. and risk management? a lot of staff have exited Then why are we hearing so much about Do I think it’s fixed yet? No, there is under these voluntary people losing cards, about people with spe- always more to do. We are acting on the programmes from cial needs or medical conditions having chief medical officer’s report into Portlao- cards withdrawn? ise and we are awaiting the findings of the areas which have been Because they either never did, or no HIQA review. development priorities’. longer, meet the financial hardship test While many recent scandals have been – Tony O’Brien set out in the 1970 legislation. I accept shocking, were you particularly shocked at that we live in a society that would prefer the way patients were treated and followed that we had a medical card system that up in the Portlaoise case? the State Claims Agency that is in charge took medical circumstances into account Yes, shocked would be the only word for of that matter. In these cases, we tell peo- in a direct way, eg. if you have X or Y medi- it. There are two issues. One is the actual ple unambiguously that their claim is now cal condition that will or won’t entitle you quality of care and the other is the way to be forwarded to, and will be managed to a medical card. There is a certain range in which patients were dealt with in the by, the SCA and no longer by the HSE. But of medical conditions where there is prob- aftermath of adverse incidents. clearly, as a society, we do need to find a ably a societal consensus that perhaps Every healthcare system in the world different and better way to settle and deal that [these conditions] should entitle will have adverse events, but the way in with cases where people have suffered people to a medical card, but, the problem which grieving parents were dealt with loss, or consequential loss, as a result of is, that is not what the law says. was, frankly, hard to comprehend. I was failings in the health system. The 1970 Act allows me to operate dis- shocked and concerned about it and It would clearly be better if there was cretion in terms of granting medical cards, that’s why I wrote the letter to all staff in a way for at least some cases to be dealt but it has to be done on an even-handed, the health service. with on a non-adversarial basis. I would equitable basis so that people in a similar I felt that there was an opportunity to hope that we can find a way where par- situation are treated in the same way and, engage people in a thought process and ents or individuals who have suffered for the moment, this financial formulaic drawing a line in saying we simply can’t harm wouldn’t have to spend so much of approach serves that purpose. do that anymore. Something seemed to their lives pursuing a case. The leadership Isn’t that a bit of a blunderbuss approach? have become accepted as normal behav- of the HSE would be strongly supportive It probably is. It’s one of the reasons iour which, objectively, was simply not of moves towards, for example, media- why I’ve put together a small group to acceptable. The message I was conveying tion and no-fault compensation. We examine whether there are different ways was ‘let’s pause for a second and say that certainly have no agenda of dragging of exercising discretion which would be must never happen again.’ cases out. equally robust in terms of satisfying the Do you accept there is a serious shortage of On the recent controversy over medical card test of good public administration, and midwifery staff in the system? cuts, the public perception is that thousands there will be a report on that in the not- Under the HSE’s Director of Nursing of people are losing their cards or having too-distant future to see whether I can and Midwifery, we are going through the them downgraded. Has the HSE failed to give directions to enable discretion to be Birthrate plus exercise. There are certainly explain to the public what it has been doing? exercised in a different way. varying patterns of ratios between mid- We haven’t failed to explain it, but I don’t I’m also concerned that standardised wives and births and we need to see how think the message has fully got through. In approaches do mean sometimes that that lays out across the country nationally the past three years there have been some people whose individual circumstances and then see what we need to do about it. changes to eligibility thresholds. That has haven’t changed at all can, on review, How does that tie in with the probably accu- affected the basic entitlement to a medical when judged against a clear rule set, see rate public perception that the HSE often card for some people. that they are no longer eligible for a medi- fights legal cases taken following adverse The discretionary route to a medical cal card. That can be very difficult for them events right up to the steps of the court? card is founded on the undue financial to understand if their individual circum- The HSE is not in charge of its own rep- hardship test – that has always been stances haven’t materially changed but, resentation where legal proceedings have transacted on the basis of a higher finan- maybe in the past, they were granted a been initiated for damages or compensa- cial threshold than the standard threshold medical card in circumstances where they tion. By statute that function is performed for a card. That’s been applied consistently ought not to have been. by the State Claims Agency. So it’s not the since the recent centralisation of the med- So we need to be able to look at ways HSE that does or doesn’t settle on the ical card service. we might be able to deal with those situ- steps, or settle in advance of the steps. As a result of that there have undoubt- ations in a more sensitive way, and we are Once legal proceedings are initiated, it’s edly been some instances where medical getting advice in relation to that.
28 WIN May 2014 Vol 22 Iss 4 Conference report Careful nursing: Principle of care in a changing environment Alison Moore reports from a recent nursing conference held by the Adelaide Hospital Society
The nursing profession is faced with the challenge of managing patient care and the need to be at the bedside, with increasing demands in terms of mana- gerial, audit and clinical duties, and all this under the ever-increasing burden of stretched staff resources. This was the At the Careful Nursing conference organised by the Adelaide Hospital Society were (l-r): Dr Therese Meehan, lecturer in backdrop to the Adelaide Hospital Soci- nursing at UCD and adjunct professor at the Graduate School of Nursing, Midwifery and Health, Victoria University of ety’s recent conference – Careful Nursing Wellington, New Zealand; Dr Ambrose McLoughlin, secretary general, Department of Health; Dr Siobhan O’Halloran, chief nursing officer, Department of Health; and Yvonne Seville, retired director of nursing, Adelaide Hospital - Sensitive, Competent, Professional Nursing, held at TCD’s School of Nursing and Mid- wifery last month. patient safety must be at the core of She stressed that she did not believe The conference was addressed by everything that we do. We also need to that the current generation of nurses leading health service policy-makers, continue to build in rewards and leader- was less compassionate than those nurses working in a variety of settings ship opportunities for nurses so that we before them but rather that the way in and clinicians. The speakers addressed the retain them in the profession and that which nursing is delivered had changed development of the profession and how their work continues to be intellectually and she felt this wider context must be best to manage patient care within an challenging and emotionally satisfying,” acknowledged. increasingly demanding environment. she said. She said that careful nursing involved Dr Siobhan O’Halloran, chief nursing Dr O’Halloran said that nurses must lead being attentive, conscientious, methodi- officer at the Department of Health, told and as a profession must “cultivate new cal, alert, tuned in, protective, sensitive, delegates that her very appointment – human capital through inspiration” and gentle, thoughtful, and seeing the whole the first at assistant secretary level – was that it must be recognised that nurses are patient and not just the illness. recognition by the government of the knowledge workers in an information age “Careful nursing is very much about an importance of nursing and midwifery in who will not respond to autocracy. embodied practice; combining health, the health service. She emphasised that values and not self heart and hand. Meeting another human “Nurses are central to our programme interest must drive decision making and and recognising their heads and hearts. of reform. By virtue alone of their num- that nurses should “think critically, care We need to use our entire selves as a bers, their adaptive capacity and their critically and act critically” at all times. nurse to treat our patients. close proximity to patients, the nurs- She said she remained confident that “We must recognise that the way we ing and midwifery professions have the the future of nursing in the Irish health give care matters,” she added. potential to effect wide-ranging changes service was safe as long as nurses contin- Dr Therese Meehan, lecturer in nursing in the healthcare system. We need to ued to be “passionate and to care”. at UCD, said that while the environment look at the role of nursing in driving for- Prof Agnes Higgins, professor of mental for nurses has changed over the past 200 ward reform and in developing our health health and head of the School of Nurs- years in terms of education and technolo- services in order to address increased ing and Midwifery at TCD said that nurses gies, the basic underlying principles of demand for high-quality, safe and effec- were coming under increasing scrutiny for nursing – compassion, kindness, calmness, tive healthcare services. failure to escalate or to lead in situations tenderness and respect for human dignity “It is the case that we have to deliver such as those at the Mid Staffordshire – have remained the same. She said the and drive these changes while managing Trust in the UK and more recently in ‘careful nursing’ model is about combin- major cost reductions but, in so doing, Portlaoise. ing this sense of humanity and the clinical
30 WIN May 2014 Vol 22 Iss 4 Conference report
skills to keep patients safe. Dr Meehan outlined the background to the careful nursing concept and discussed how it was first implemented in the US and in New Zealand, where pilot studies yielded consistently positive results. Dr Meehan discussed a careful nursing pilot study in a ward at St Vincent’s Hospi- tal, Dublin, which found it had a beneficial impact on delivery of care. Funding is now being made available to introduce the approach across the wider hospital. “In the current environment with its focus on cost containment and perhaps an over-emphasis on procedures and pro- cesses rather than on patients, we need to remember that nurses are particularly well placed to be the eyes and ears of our Pictured (l-r) at the careful nursing conference were: Sarah McMickan, director of nursing, Tallaght Hospital; Yvonne health services in best managing patient Seville, former director of nursing at Tallaght Hospital; and Hilary Daly, deputy director of nursing, Tallaght Hospital care. It’s important that we don’t forget that, and that the nursing profession con- tinues to be at the left, right and centre of everything that we do,” she said. Yvonne Seville, the first deputy director of nursing at Tallaght Hospital, now retired, spoke about how much the profession of nursing had changed from the time it first became a regulated profession in Ireland in 1921. She recalled the words of the first matron she trained under who informed the new entrants that “a nurse walks smartly and never runs, unless in the case of fire and haemorrhage!” She recalled being given detailed instructions on dusting, the iron rule of the hospital sisters and the fact that first Also pictured were (l-r) : Prof Agnes Higgins, professor of mental health and head of the School of Nursing and Midwifery, TCD; and Dr Catherine Darker, Adelaide assistant professor in health services research, TCD Centre for Health Sciences names were never used, either for the nurse or the patient. This was something she said that should still be borne in mind fessor in health services research at the to host this conference, with a wish to when addressing a patient as not every- TCD Centre for Health Sciences, said that ”ensure that patient care continues to be one likes to be addressed casually. the concept of the caring nurse has to be our primary focus. For over 150 years, the When she commenced her training, Ms at the core of the 21st century professional Adelaide has been training nurses and we Seville said that the hierarchy of nurses, nurse’s toolkit. have seen huge changes within the pro- from trainee to staff nurse to ward sis- “At a time of significant pressures within fession during that time. But one thing ter to matron was easy for a patient and the health service, and high burnout and has remained constant when it comes to their family to understand. Now there are low morale for some within the profes- best outcomes for patients – what we call a host of new grades under new names sion, we need to make sure that we are not the ‘careful nurse’ approach, where nurses which might not be grasped by those out- storing up nursing care problems that will have meticulous attention to detail in all side the system. come home to roost,” she said. aspects, from elementary personal care Ultimately, however, despite the evo- She added there is a concern that in a through to the most complex clinical pro- lution of the nurse’s role into greater situation with decreasing staff numbers cedures. We need to ensure that nothing autonomy and a wider scope of clinical and with additional responsibilities being happens with the ongoing development practice, she said that the relationship of placed on nurses, that the time spent car- of our health service that would change trust between patients and their nurses ing for patients would be diminished, this in any way. Our patients and their fam- remained and was a fundamental part of with the potential for patient care to be ilies deserve no less,” she concluded. the nursing profession. neglected and warning signs go unseen. INMO president Claire Mahon was in Also speaking at the conference, Dr It was for this reason she explained, attendance at the conference and reports on Catherine Darker, Adelaide assistant pro- that the Adelaide Hospital Society chose it on page 51.
WIN May 2014 Vol 22 Iss 4 31
Art and Science of Antenatal Education
Tuesday, May 27 and Wednesday, May 28 2014
Professional Development Centre, INMO, The Whitworth Building, North Brunswick Street, Dublin 7
INMO members: €150; Non-members €280
Book by Credit/Laser Card by calling 01 664 0641/18 Complete details of this programme are available on www.inmo.ie
This two day workshop will prepare midwives to design an effective antenatal education programme for expectant mothers and fathers. The philosophy of this course is based on the principles of adult learning and on the belief that antenatal education is a health promotion activity. This course will prepare midwives to encourage expectant parents to see themselves as competent and able to make informed choices for themselves and for their baby.
Category 1 approved by the Nursing and Midwifery Board of Ireland (NMBI) = 10 Continuing Education Units (CEUs)
Day 1 Day 2 9.45am Registration 10.00am Recap of Day 1 learning 10.00am Introduction, aims and objectives 10.15am Parenting activities and Lessons 10.15am Teaching and learning strategies 11.15am Pre and postnatal depression 11.15am Labour practical workstation 11.45am Breastfeeding 12.00pm Pelvic floor learning activity 1.30pm Still birth and cot death 1.30pm Making normal birth a reality 2.30pm Baby massage demonstration 2.30pm Assisted birth and caesarean birth 3.00pm Written and practical assessment 3.30pm Group yoga and meditation 3.30pm Course feedback/evaluation 3.50pm Summary and home work Professional Development Centre Conferences • Workshops • Seminars
Your career development is important to the INMO. The Professional Development Centre is committed to providing high New quality, relevant and up-to-date programmes for Irish nurses and midwives. For further information contact: INMO Professional Development Centre, Whitworth Building, Courses North Brunswick Street, Dublin 7. Tel: 01 664 0641/2. Email: [email protected] 2014! Information on all courses is also available on our website www.inmo.ie All courses listed are held in the Professional Development Centre, INMO, North Brunswick Street, Dublin 7. Courses are limited to 15 participants and under (except in exceptional circumstances).
Check out our New Courses at the Professional Development Centre! For more information log onto www.inmo.ie
Art and Science of Antenatal Education This two day workshop will prepare midwives to design an effective antenatal education programme for expectant mothers and fathers. See page 32 for further information. Date: May 27/28, 2014. Fee: e150 members; e280 non-members
Assessment and Care Planning for Older People in Residential Care This workshop is aimed at providing nurses working in this sector with the most up-to-date information regarding policy and Leg Ulcer Study Day standards in older person care and will focus on the need for This workshop will enable practitioners to explore and comprehensive assessment, including risk assessment and care analyse current theories and practice in relation to planning for older people in residential care settings. patients with leg ulcers. Aims include to: distinguish Date: May 26, 2014. Fee: e80 members; e140 non-members between the different causes of ulceration and associated pathophysiology and relate to epidemiology, risk factors Assessment and Management of the Diabetic and assessment; review the nurse’s role in assessment of patients with leg ulcers; review the role of Doppler in the Foot assessment of the lower limb; appraise the evidence for This programme will support the professional decision making compression therapy and relate this to current practice; of nursing staff who care for patients with, or who are at risk of, explore the impact of psychosocial issues relevant to diabetic foot. It ensures that nurses and midwives use evidence- managing patients with leg ulcers and suggest strategies based practice to ensure patients’ needs are met. It allows nurses/ to incorporate these within clinical practice; and explore midwives to ensure they are competent and working within their the importance of the multidisciplinary team and the role scope of practice in accordance with their Code of Professional of specialist clinics in the assessment and management of Conduct. patients with leg ulcers. Date: July 8, 2014. Fee: e80 members; e140 non-members Date: May 20, 2014. Fee: e80 members; e140 non-members Best Practice in Medication Management Advanced Diabetes Management This study day provides participants with an overview of the main This workshop is aimed at nurses and midwives who have issues associated with medication errors and near misses and a good understanding of basic diabetes management and explores evidence-based approaches to promote and implement want to build on their knowledge. The workshop will cover safe medication practice. It helps participants to understand the injectable therapies for people with diabetes, carbohydrate 'risk management' approach to safe medication management counting for type 1 diabetes, complications of diabetes and practice in an organisation. It is underpinned by legislation and by advances in future management of diabetes. NMBI guidelines. Date: May 26, 2014; Fee: e80 members; e140 non-members Date: May 12, 2014. Fee: e80 members; e140 non-members
are the Official Sponsors of the Professional Development Centre All programmes have Category 1 approval from the Nursing and Midwifery Board of Ireland
participants' previous knowledge and understanding of diabetes. Are you ready for thematic Other topics include the evidence base for advanced diabetes man- agement, legal and professional frameworks, accountability, patient inspections? centred care, self-management and concurrence. HIQA will be undertaking thematic Date: June 11, 2014; Fee: e80 members; e140 non-members inspections in 2014 in the following two areas: Facilitation Skills, Behavioural Interventions • End of Life Care and Motivational Coaching for Nurses and • Food and Nutrition Requirements. Midwives To assist nurses in preparing for This interactive course aims to equip nurses and midwives these inspections, the INMO have with the skills they require to educate patients and others. developed the following workshops: It provides the knowledge, skills and confidence to facilitate certain types of health behaviours in the promotion of good End of Life Thematic Inspections health. It outlines the principles of adult learning and helps This one day workshop is aimed at registered participants to identify their own learning styles and those of nurses working in designated centres for older others. Sessions on effective communication, listening, assessing people. It will outline the HIQA standards and and evaluating will be facilitated throughout the day. Key aspects provider guidance on end of life care for designated of motivational coaching will also be explored. Participants will centres. The workshop will focus on assessment, planning, also learn foundational and theoretical knowledge for working implementation and evaluation of care to meet the end with individuals presenting with behavioural challenges when of life care needs of residents. The use of specific disease making health and lifestyle changes. This education programme trajectories and clinical prognostic indicators to assist with promotes excellence amongst nurses and midwives who provide assessment and care planning will be discussed. care to patients who may need support, advice and education Date: July 22, 2014. when facilitating certain types of health behaviours in the promotion of good health. Fee: e80 members; e140 non-members Date: June 26, 2014. Fee: €80 members; €140 non-members Food and Nutrition Thematic Inspections Healthcare Provider CPR & AED Course – This one day workshop is aimed at registered The New 2010 Guidelines nurses working in designated centres for older people. It will outline the HIQA standards and This one-day course is the newly released 2010 American Heart provider guidance on food and nutrition for designated Association’s (AHA) guidelines for CPR and ECC for healthcare providers. The changes from the A-B-C Sequence to the C-A-B centres. The workshop will focus on assessment, planning, Sequence, and the rationale behind it, are explained in detail implementation and evaluation of care to meet the food while providing the maximum time for each participant to gain and nutrition needs of residents. Particular emphasis will the skills of resuscitation. The content of this course includes: be placed on identifying and monitoring ‘at risk’ residents. adult, child and infant CPR; bag and mask ventilation; foreign Date: July 23, 2014. body airway obstruction; use of the AED for adult and child. e80 members; e140 non-members Fee: Before the course you will receive the new 2010 BLS for Healthcare Providers textbook. Limited to six participants per instructor. A fee of e50 will be charged if you wish to cancel Competency Based Interview your booking 10 days before the course begins. Congratulations, you have been called for interview. Now your Date: May 23, 2014. Registration: 9.00am. success in the interview is all up to you. The aim of this interactive Time: 9.15am-4.00pm. Fee: e125 members; e195 non-members workshop is to help you prepare for the competency based (including cost of book and light lunch) interview and to enhance your interview skills. During this training participants will have a greater understanding of competency Hepatitis C and the Intravenous Drug Using based interviews and the methods employers use to assess Patient candidates. This course aims to give an overview and sound knowledge base Date: May 22, 2014; Fee: e80 members; e140 non-members of hepatitis C, with particular focus intravenous drug use. It is divided into four main sections; transmission, diagnosis, disease Diabetes Management in Care of the Elderly monitoring/treatment and finally, challenges and barriers faced This study day will focus on a number of key areas in diabetes by clients who have contracted hepatitis C through drug use. This management in care of the elderly; basic nursing management course would be of use to nurses and midwives working with of diabetes, effective blood glucose management, medication hepatitis C positive patients in a hospital, general practice or com- management, complications, barriers and challenges in nursing munity setting. the older person with diabetes. It will emphasise safe and effec- Date: May 21, 2014. Registration: 9.30am. tive management within clinical practice, as well as building on Time: 10.00am-2.15pm. Fee: e40 members; e70 non-members
are the Official Sponsors of the Professional Development Centre Professional Development Centre
INMO Safe Practice Campaign The Professional Development Centre is providing a nationwide series of workshops in workplaces and venues across the country. The aim of these workshops is to advise INMO members on key areas of practice such as clinical risk, report writing and statement writing, documentation and professional misconduct complaints to the Nursing and Midwifery Board of Ireland (NMBI). Category 1 Approved by Nursing and Midwifery Board of Ireland (NMBI) = 4 CEUs Dates: May 1 – Springford Hall, Mallow; May 2 – Mount Errigal Hotel, Letterkenny; May 15 – St Patrick’s Centre, Kilkenny; May 17 – Professional Development Centre, INMO; May 19 – Portlaoise Parish Centre; May 20 – Falls Hotel and Spa, Ennistymon; May 21 – Our Lady of Lourdes Hospital, Drogheda; May 22 – St Luke’s Hospital, Kilkenny More dates and venues are available on our website www.inmo.ie TOOLS FOR To book a place please email [email protected] or call 01 664 0616 Fee: INMO members Free; e75 non-members. SAFE PRACTICE
Introduction to Infection Prevention and necessary knowledge, skills and confidence to evaluate and Control manage the nursing care of a patient with a tracheostomy. Date: May 13, 2014. Fee: €80 members; €140 non-members The aim of this course is to provide nurses with an overview of infection prevention and control. It be of particular interest to nurses in the non-acute setting such as nursing homes, mental Management Skills for Clinical Nurses health, intellectual disabilities and community care. Topics Managers and Staff Nurses include: history of infection control and basic microbiology; This course is aimed at equipping clinical nurse managers standard precautions and how they apply to individual settings; and staff nurses with management skills. Key topics include: important documentation; introduction to the HIQA Standards management principles; decision making; team building; for Prevention of Healthcare Associated Infections. Attendees motivation of staff; and managing different skill mixes. will receive certification in hand-hygiene training (skills Date: May 15, 2014. Fee: €80 members; €140 non-members training). € € Date: May 14, 2014. Fee: 80 members; 140 non-members Non-Violent Crisis Intervention Introduction to Clinical Audit This one-day programme is designed to assist staff to provide the best care, safety and security for staff working in healthcare The aim of this one-day workshop is to introduce participants environments. The programme identifies behaviours that con- to the theory and practical application of clinical audit in Irish tribute to the development of a crisis and outlines appropriate healthcare. It is designed to provide participants with the staff intervention for each response. It also identifies verbal and necessary skills to implement clinical audit in their practice and non-verbal techniques to de-escalate behaviour. In addition the be able to deliver evidence of improved performance for safer course outlines break-away techniques that can be adopted in and better care for patients. It also gives participants the tools a physical crisis situation while maintaining the care, welfare, to demonstrate a baseline of performance and how to monitor safety and security of clients and staff. It also helps participants quality improvement over time and introduce quality control in to identify the triggers and patterns of behaviour and, therefore, the current and future regulatory environment. develop a person-centred care plan and a consistent approach in € € Date: June 25, 2014. Fee: 80 members; 140 non-members order to prevent the behaviour from reoccurring. Date: July 16, 2014. Registration: 9.15am. Introduction to Palliative Care Time: 9.30am-1.00pm. Fee: €80 members; €140 non-members This one-day course will introduce participants to the basic concepts of palliative care – caring for people suffering from a Nursing Management of Diabetes terminal illness as well their families. The course will focus on Complications physical, psychosocial and philosophical aspects of palliative care. This one-day workshop aims to equip nurses who care for people Specifically, the ethos of palliative care, symptom control and psy- with diabetes with the knowledge, skills and evidence base chological care will be examined. regarding diabetes complications. Both macrovascular and micro- Date: May 13; July 30, 2014. vascular complications will be covered as well as lesser known Fee: €80 members; €140 non-members complications. Risk assessment, screening tools, lifestyle man- agement, optimising glycaemic control, treatments and nursing Management of Patient with Tracheostomy management will also be explored. This one-day workshop will provide the participants with the Date: July 17, 2014. Fee: €80 members; €140 non-members New Courses 2014
Pressure Ulcer Prevention and Management Wound Care Management The aim of this workshop is to enable the practitioner to analyse This one-day workshop will cover all aspects of wound their current practice and identify knowledge, strategies and management including the physiology, assessment, cleansing and skills that will improve outcome and quality of care in relation to management of wounds. patients with, or at risk of, pressure ulceration. Date: June 17, 2014. Fee: e80 members; e140 non-members Date: June 24, 2014. Fee: e80 members; e140 non-members Recognising and Responding to Elder Abuse This course is designed to assist nurses to gain knowledge in the recognising, responding and reporting of elder abuse. The INMO Courses – Cork course provides definitions of the various types of elder abuse See page 41 for information on the and educates staff on how to recognise the signs of elder abuse and poor care practices that may be occurring. It will also inform courses that will be run at the staff of the correct actions to take if they discover or suspect elder abuse. INMO Cork Offices Date: June 11 2014. Fee: e80 members; e140 non-members
Nursing the Cardiac Patient ECG Interpretation This one-day workshop is aimed at enhancing general This one-day workshop is aimed at enhancing general nurses' knowledge of management of the cardiac patient. nurses' knowledge of cardiac electrophysiology. It will Topics covered in this one-day workshop include cardiac provide participants with knowledge of cardiac rhythms, anatomy and physiology, cardiovascular assessment, cardiac rhythm analysis and ECG interpretation (It is advisable to tests, medications, chest pain and heart failure. do the workshop on July 24, 2014, Nursing The Cardiac Registration: 9.00am. Time: 9.30am-4.00pm Patient also). Date: July 24, 2014. Date: July 25, 2014. Time: 9.30am-4.00pm Fee: e80 members; e140 non-members Fee: e80 members; e140 non-members
Early bookings are Application Form for PDC Courses advisable
Name:
Address: Working Together
Tel (home/mobile):* Tel (work): BOOK BY CREDIT/LASER CARD Email: Call 01 664 0641/2 Job title: Place of employment: Fee enclosed: £ Title of workshop: Have you attended an INMO workshop before?: Yes q No q (Cheques/postal orders payable to ‘INMO’. Receipts will be issued a week prior Date of workshop: to course start date). Venue of workshop: INMO Member: q Membership No: * Supply of a personal contact number is essential, in case of the unlikely event Non-member: q of late cancellation of a course If you have any special dietary requirements please contact us at least five Are you a registered Nurse q Midwife q days in advance at Tel: 01 664 0642
Please return form to: Professional Development Centre, INMO, Whitworth Building, North Brunswick Street, Dublin 7
Venue and times of workshops: Unless otherwise stated, courses listed are held at the Professional Development Centre. In order to better facilitate people attending workshops in the PDC, registration for most full-day workshops will take place at 9.45am and the courses will commence at 10.00am. Cancellation policy: In the event of unforeseen circumstances, a facilitator/trainer may be replaced by another suitably qualified person. Cancellation of any course must be given in writing at least seven days before the course begins. Fee will be refunded minus an administration charge. If a person cancels in less than seven days, no refund will be given. Receipts will be issued a week prior to course start date.
INMO COURSES COMING TO CORK OFFICE Sheraton House, Hartlands Avenue, Glasheen, Co Cork
All programmes have Category 1 approval from An Bord Altranais agus Cnáimhseachais na hÉireann
End of Life Care for Older People May 16, 2014 This interactive course identifies the main principles in end of life care for the older person. The rationale for this course is to improve knowledge and highlight the holistic care, inclusive of physical, spiritual, psychological, financial, emotional wellbeing, for a client and their family at end of life.
Delegation and Clinical Supervision May 26, 2014 This workshop explores the issues surrounding delegation and decision making, including appropriate supervision and delegated functions. It is aimed towards all nurse/midwife managers working with healthcare assistants.
Food and Nutrition Thematic Inspections June 9, 2014 HIQA will be undertaking thematic inspections – are you ready? This one day workshop is aimed at registered nurses working in designated centres for older people. It will outline the HIQA standards and provide guidance on food and nutrition for designated centres.
Understanding Obesity and Weight Management June 16, 2014 This one day workshop aims to provide a comprehensive understanding of the cause of obesity and the physiological principles involved in the onset of obesity and associated illness. Lifestyle treatment options such as dietary, exercise and behavioural interventions will be covered in depth, as well as non-pharmacological, pharmacological and surgical interventions.
Management Skills for Clinical Nurse Managers and Staff Nurses July 21, 2014 This course is aimed at equipping clinical nurse managers and staff nurses with management skills. Key topics include: management principles, decision making, team building, motivation of staff and managing different skill mixes.
Fee: €80 INMO members; €140 non-members. Book by credit/laser card by calling 01 664 0641/2 Please note that there is very limited onsite car parking
Information on all courses is available on our website www.inmo.ie Focus Progress in healthcare The Irish Research Nurses Network is increasing the knowledge base and professional recognition of clinical research nursing in
Ireland David O’Brien, INMO Executive Council member, with delegates at the IRNN conference in University College Cork
There was a record attendance at the nurses on their own research sixth annual conference of the Irish areas. This part of the conference was next stage of the project. Research Nurses Network (IRNN) in Uni- chaired by Josephine Hegarty, professor The IRNN once again hosted the pres- versity College Cork (UCC) in November. of nursing and director of graduate stud- entation of certificates to nurses who The theme of the conference was ies at UCC. completed the postgraduate programme ‘National Harmonisation of Clinical Dr Claire Magner, clinical audit and for clinical research nurses in the RCSI Research’ and during the morning ses- research nurse at Our Lady’s Children’s Faculty of Nursing and Midwifery. This sion, chaired by Dr Sarah Condell, Nursing Hospital in Dublin, presented a summary NUI accredited programme is now in its Research Advisor of the Health Research of her project ‘Analgesia and Sedation fifth year and has made a major contri- Board (HRB), the audience heard talks on Management in PICU: The Impact of New bution to increasing the knowledge base the topic by: Prof Joseph Eustace, clinical Guidelines on Patients and Staff’, which and professional recognition of clinical director of the HRB-funded Cork clinical has had a meaningful impact on the clini- research nursing in Ireland. research facility (CRF); Dr Catriona Creely, cal practice in the use of analgesia and The certificates were presented by Prof programme manager of clinical and sedation in children in a paediatric inten- Zena Moore, head of the faculty of nurs- applied biomedical at the HRB; and Han- sive care unit (PICU). ing and midwifery at the RCSI. nah Reay, lead nurse of the NIHR Clinical Siobhan McFadden from the Royal Col- The conference closed with the presen- Research Network and co-chair of the lege of Surgeons Ireland (RCSI) Clinical tation of the poster awards. Posters were Birmingham Region Research Training Research Centre presented her study, ‘An presented on a variety of topics reflecting Collaboration (BRTC). exploration of the psychological indica- multidisciplinary and nurse led research. Dr Mary Clarke Moloney, vascular tors of aspirin adherence in patients with First prize went to Ann Collins, RCSI clini- research manager at the HSE in Limerick, stable coronary artery disease’, which cal research co-ordinator, for her poster, ‘A launched, on behalf of the IRNN working provided an interesting insight into the questionnaire to explore the motivations group, the Clinical Research Nurses Ori- support provided by significant others in and experiences of healthy volunteers entation Pack. This is a practical resource relation to medication compliance. who were screened to participate in a that can be used in any research setting Jennifer Connolly, research nurse at Phase I Malaria vaccine study’. by nurses who are new to the research the Alimentary Pharmabiotic Centre and The runner-up prize was awarded nurse role and/or to the particular area ELDERMET study in UCC, presented her to Siobhan McCoy, PhD student in the of practice. It is available on request from paper, ‘Are there signs of palmar skin National Children’s Research Centre, for the IRNN (email: [email protected]) or on the hyperlinearity at birth which can predict her poster ‘Paediatric Procedural Sedation Molecular Medicine Ireland (MMI) website: atopic eczema at six months?’ in the Emergency Department - Results www.molecularmedicineireland.ie Laura Dunne and Lorna Green from TCD from our Sedation Registry’. Following favourable feedback from gave an update on the progress of the Deirdre Hyland, Royal College of Surgeons Ireland; previous IRNN annual conferences, pres- TILDA study, and highlighted opportuni- Virginia Walls, Molecular Medicine Ireland; and Susan entations were provided by research ties for nurses to become involved in the Lennon, Irish Clinical Research Infrastructure Network
WIN May 2014 Vol 22 Iss 4 43 Lean machines Hospitals worldwide are using ‘Lean’ management principles to streamline processes, reduce costs and improve quality and services
Lean improvements have been initiated every process is the beginning of the jour- actions and the corresponding effects on in hospitals worldwide for the benefit ney toward Lean operations. organisational goals. of patients, employees and healthcare Lean is a proven methodology that Lean at the Mater organisations. Hospitals, including the answers the question: how is a health- In 2011, the Mater hospital established Mater Hospital in Dublin, are success- care organisation going to do more with a Strategic Lean Group to prepare for the fully using Lean thinking to streamline fewer resources? It is important for the relocation of services to the new Whitty processes, reduce costs and improve qual- healthcare organisation to have a formal Building. This involved training for staff ity and timely delivery of products and Lean infrastructure that can help build the in Lean Six Sigma principles to improve services. adaptive capacities needed to respond patient outcomes while generating econ- Lean management principles are being to the internal and external challenges omies by reducing waste. successfully applied to the delivery of that occur. This infrastructure provides a Although Lean Six Sigma had been healthcare and even though the princi- governance framework to oversee Lean running in the hospital since 2011, the ples of Lean are not typically associated projects that result in patient benefits and Mater Lean Academy launch in 2013 with the sector, they do work in health- operational efficiencies. was the final step in the consolidation care organisations. A Lean healthcare organisation will be of a Lean infrastructure with systems to Lean thinking begins with driving out better able to embed strategic principles support change management initiatives. waste so that all work adds value and in every department and measure results The academy’s mission is to improve serves customer needs. Identifying value- with a metric system that allows manag- healthcare quality, patient safety and effi- added and non-value-added steps in ers to understand the link between its ciency by applying the principles of Lean
44 WIN May 2014 Vol 22 Iss 4 Focus
Seán Paul Teeling, Lean Six Sigma programme co-ordinator engineering, management and science. complete the White Belt Pro- To meet the HSE’s demand for quality gramme can progress to the healthcare at affordable prices, the acad- Green Belt Programme, which is emy works on the latest strategies and accredited by the UCD School competencies to improve care, manage of Nursing, Midwifery and margins and facilitate compliance with Health Systems. In addition to national guidelines. Mater Lean Academy awarding 10 European Credit programmes are accredited by its aca- Transfer and Accumulation demic partner, UCD. System (ECTS) credits, the pro- The academy believes that quality gramme also offers a route into improvement initiatives that result in bet- the interdisciplinary profes- ter patient care and improved provider sional certificates and a Masters margins directly correlate with, and are in practice innovation. sustained by, the skills and knowledge Studies suggest that leader- possessed by all levels of healthcare pro- ship management support and fessionals and support staff. a continuous learning environ- Lean Six Sigma in healthcare: ment are important facilitators • P rovides better patient care of Lean implementation. • Impr oves the patient experience To increase the success- • O ffers better value for money processes ful outcomes of leadership • Ensur es quicker access to diagnostics actions, interdisciplinary train- • P rovides earlier effective treatment ing is supplemented with actions to nursing, dietetics, speech and language • Maximises business and income gen- remove perceived barriers. This requires therapy, and catering staff to ensure that eration capacity the involvement of all professionals, the patients requiring assistance with eat- • M inimises queues and waiting times crossing of departmental boundaries and ing and nutrition, received their meals • Optimises payment by results. a focus on meaning-making processes, on time and with the help necessary to Although healthcare differs in many rather than simply ‘implementing’ actions. ensure nutrition, hydration and patient ways from manufacturing, there are also Research suggests that programme par- wellbeing were maintained. surprising similarities: workers must rely ticipants, such as staff members and The project was piloted in 2012, follow- on multiple complex processes to accom- leaders, can mutually explore the mean- ing a reference site visit to the Pembury plish their tasks and provide value to the ings of Lean thinking and working for Hospital in Tunbridge Wells. A ‘coloured customer or patient. Waste of money, their own contexts. tray initiative’, based on the Pembury time, supplies or goodwill decreases value. By engaging in this shared, experiential experience was introduced and is now However, when applied rigorously and learning process, the ownership of Lean running in seven of the 13 Mater hospi- throughout an entire organisation, Lean implementation can also increase. Inter- tal wards with consolidation and roll-out principles can have a positive impact on disciplinary projects to date in the Mater to all wards continuing incrementally. productivity, cost, quality and the timely include: The participants in the ‘Our Daily Bread’ delivery of service. • Patient nutrition project worked on this as part of their Medical care is delivered in extraor- • ED to wards pathway progress towards a LEAN Six Sigma Green dinarily complex organisations with • Community referrals Belt Special Purpose Award, which they thousands of interacting processes, much • Ultrasound workflow received in December 2013. like the manufacturing industry. Studies • E cho workflow and processes In addition to training staff in Lean have shown that Lean has a wide range of • Porter services methodologies and applications, the applications to hospital operations which • P atient way finding Mater Lean Academy offers quality include: reducing inappropriate hospital • T heatre turn around time improvement projects that incorporate stays; improving the quality and financial • S troke thrombolysis time consulting, coaching, and training services efficiency of trauma care; reducing the • Phlebotomy for Mater hospital healthcare profes- cost of temporary staff; improving oper- • Drug rounds sionals, support services and staff in all ating room and emergency department • Ward cleaning capacities. The primary goal of all projects, efficiency; improving radiology processes; • Interruption reduction. rapid improvement events and consulta- and reaching better strategic decisions All projects are made possible only tions is to achieve direct patient benefit affecting marketing and capacity man- by the time, professionalism, dedication and outcome as well as cost savings. agement, among other strategies that and interdisciplinary collegiality of the Seán Paul Teeling is a Lean Six Sigma programme lead to improved hospital profitability. nursing, medical, allied health and other co-ordinator In the Mater, there is a weekly ‘White professional and support services within For further information on undertaking university- Belt’ introduction to Lean programmes, the hospital. accredited, hospital-based, Lean Six Sigma training at given by experienced ‘Black Belts’ and An example of this interdisciplinary the Mater Hospital, please contact Michelle McGuirk. Email: [email protected], Tel: 01 8097463 or consult the ‘Master Black Belts’ in the hospital set- work ethic was the ‘Our Daily Bread’ Mater Lean Academy at http://www.mater.ie/education/ ting. Participants who successfully project, which was set up by a team of materleanacademy/
WIN May 2014 Vol 22 Iss 4 45 Focus Sharpen up on safety The implementation of the EU sharps directive in Ireland has been less than satisfactory and must be addressed, writes Emer Costello
The deputy general secretary of the INMO, importance of effective trade unions work- strategy, which was supposed to be in place Dave Hughes, has stressed the importance ing at both European and Irish levels to win last year. The delay occurs at a time when of nurses and midwives lobbying candi- health and safety and other protections. So over 5,000 tragic deaths occur in European dates for the European Union elections much of our health and safety law comes workplaces each year. to review Ireland’s implementation of the from Brussels and – notwithstanding the “In Ireland, 47 people died at work last sharps directive. difficulties that often seem to dog the pro- year. Meanwhile, the number of workplace The implementation of the directive cess of Irish implementation of EU directives inspections carried out by the Health and by statutory instrument under the EU Act – the sharps directive demonstrates that Safety Authority (HSA) is falling. HSA chair- was described by Mr Hughes as less than European legislation is still vital in protect- person Michael Horgan warned last year adequate. He condemned the fact that ing health workers’ rights and safety. that the continuing loss of HSA staff will Irish law now allows for recapping of nee- “I have asked the European Commission lead to a reduction in standards and an dles in some circumstances and identified to assess Ireland’s implementation of the increase in workplace injuries and costs. other difficulties with the legislation. For sharps directive and to spell out what action “The sharps directive shows how action example, enforceability is dependent on it will take to ensure its full and correct at European level can deliver practical help. inspectors rather than an employee pro- implementation. That’s why there’s an urgent need for a new cedure for making complaints, as is the “It’s incredible to me that basic rights EU health and safety strategy. Apart from case under the Health and Safety Act. Also, to a safe and healthy workplace are now its practical effect, it would send a message the definition of ‘employer’, to whom the being questioned by many in business and that the EU values the safety of its people legislation is applicable, is ambiguous. politics, here and across the continent. I fre- and communities ahead of the convenience According to Mr Hughes, the INMO quently hear industry lobbyists arguing for of powerful corporations who would hap- is very disappointed with how the EU weaker workplace protections. This mood is pily use the economic crisis to erode vital directive has been treated by the Irish gathering pace in the corridors of European workplace safety protections. government. The INMO invested a great power, where some are happy to accept “Last year the European Commission deal of work into the directive, so it is the argument that effective safeguards like launched a consultation on the proposed frustrating that the government was in the sharps directive are nothing more than new strategy. Unions and their federations breach of the deadline for its implementa- administrative burdens on management in Europe are using the opportunity to make tion, and has loosely applied the directive and business. the case for strengthened workplace safety with regard to the recapping of needles. This demonstrates the growing need for measures. You can be sure that those who Mr Hughes raised this issue with MEP effective trade unions, working with MEPs write off modern safety procedures as ‘red Emer Costello, who has committed to pur- who respect health staff and understand tape’ are doing the same. sue an assessment of the application of the realities of working life in hospitals and “I know that the INMO will continue to the directive in Ireland. Her letter of reply, elsewhere, if we want to maintain and keep work for improved rights to compensation, said: improving the vital health and safety pro- vaccination and counselling if a nurse or “It must have been a frustrating experi- tections that Europe has delivered. midwife suffers a sharps injury. The union ence. The implementation came almost 10 “In the European Parliament last Sep- needs an effective voice in the European months after the EU deadline and the form tember, I quizzed the EU commissioner Parliament and other EU institutions to help of implementation chosen by Irish officials responsible for workplace safety about in this important work.” was convoluted to say the least. Neverthe- unacceptable delays in implementing and Emer Costello is member of the European Parliament less, the entire process demonstrates the introducing a new EU health and safety for Dublin
WIN May 2014 Vol 22 Iss 4 47 Aileen Rohan from the INMO library team suggests some useful resources and INMO workshops available on diabetes care Diabetes care Diabetes is a serious life-long disease screening and education of the patient One2One information retrieval training for individuals and unlike other chronic with diabetes in foot care is guided by the One2One training is on offer to assist diseases, it cannot be cured, but only con- National Diabetes Programme Model of you in searching the internet and elec- trolled. Control of the complications of Care for the Diabetic Foot tronic databases in order to find the diabetes is essential to the quality of life of Other articles relevant information. This is a skill which is affected people. • Gallagher, N, Bennett, K, Smith, S M, extremely useful for the rest of your career The health services spend large O’Reilly, D. (2014). Impact of two differ- for professional development and career amounts of funding on diabetes care, ent health systems on the burden of advancement. particularly in the area of treating compli- type 2 diabetes. Journal of Health Services To avail of training for yourself or a cations. Better management and control Research and Policy. 19(2): 69-76 small group, just contact us to make an of diabetes, together with early detec- • McDermott, A M, Kidd, P, Gately, M, Casey, appointment. tion and treatment of complications will R, Burke, H, O’Donnell, P, Kirrane, F, Din- Contact the library reduce complications, bringing both ben- neen, S F, O’Brien, T. (2013) Restructuring The library staff can be contacted efit to the individual and to the health of the Diabetes Day Centre: a pilot lean directly from 8.30am-5pm from Mon- services. project in a tertiary referral centre in the day to Thursday, and 8.30am-4.30pm The Professional Development Centre West of Ireland. BMJ Quality and Safety. on Friday. Tel: 01 6640614 or email: has put together Diabetes Workshops 22 (8): 681-8. [email protected] focusing on the assessment, care and • Begley, T. (2013) Transition to adult care for management of diabetes patients. Further young people with long-term conditions. Diabetes workshops information is available on the INMO web- British Journal of Nursing. 22(9): 506-11 site (www.inmo.ie) and bookings can be • Kelly, S, Dolan, C, Hurley, L, Kelly, L, Garrow, Professional Development Centre, made by telephoning: 01-6640641/2. A, O’Shea, E, Glynn, L, Dinneen, S. (2010). INMO HQ Below are some of the more important Prevalence of diabetic foot complica- • May 26, 2014: Advanced Diabetes national documents from the HSE on the tions in the west of Ireland: a pilot study. Management – 5 CEUs management of diabetes as well as some Diabetic Foot Journal. 13(2): 82-91 recent articles on research studies about • Turns, M. (2012). The diabetic foot: an • June 11, 2014: Diabetes Management in diabetes from Irish authors. overview for community nurses. Brit- Care of the Elderly – 5 CEUs Important HSE documents ish Journal of Community Nursing. 17(9): • July 8, 2014: Assessment and Management • HSE (2008). A Practical Guide to Integrated 422-433 of the Diabetic Foot – 5 CEUs Type 2 Diabetes Care Literature searching service • July 17, 2014: Nursing Management of • HSE West (2009). Diabetes Resource Man- If you are looking for a specific policy Diabetes Complications – 5 CEUs ual, 2nd Edition or guideline, or if you need to update cur- • HSE (2010). Guidelines for the Manage- rent policies, INMO library staff can assist These courses can be provided on site in your own ment of Pre-gestational and Gestational by undertaking the search on your behalf. facilities. For details, Tel: 01 6640641/2 or email: [email protected] Diabetes Mellitus from Pre-conception to Simply phone or email the library at any the Post natal Period time and staff will take some details on These workshops are Category 1 approved by the Nursing and Midwifery Board of Ireland (NMBI) • HSE (2011). Nursing practice in foot what you are looking for. This costs €6.
WIN May 2014 Vol 22 Iss 4 49 OnOn thethe ground ground withwith thethe presidentpresident
Adelaide Hospital Society New Executive Council The Adelaide Hospital Society Since last month the Executive Coun- invited me to attend their nurs- cil Elections have taken place. I would ing conference which had as its like to congratulate all of you who have theme ‘Careful nursing – sensitive, been elected. A sincere thanks to all competent, professional nursing: who came forward for election and to Closing the gap between nursing all of you who took time to use your practice and nursing science in vote. For full details on the new Execu- contemporary nursing in Ireland’. tive please see pages 6-7. It was an excellent day giving both the patient and the nurse’s At the Adelaide Hospital Society meeting in TCD were: Claire Mini Marathon perspective on experiences and Mahon, INMO president; Rosin Whiting, chief executive of Ade- initiatives that are being rolled laide Hospital Society; and Ann Maher, Galway Mayo Institute of This year’s Flora Women’s Mini Mara- out in Tallaght Hospital. Technology thon will take place on Monday, June 2. I will lead an INMO group raising funds on behalf of the Alzheimer’s Society of Section conferences Ireland. Please let me know if you have Itt a ended the ODN Section conference, which was held in Limerick in March. The registered so that you can join me, theme for the day was ‘Operation Excellence’. It was a very informative conference my daughters and the INMO group. with an excellent line up of speakers and it was very well attended. There were a I would also like to mention the number of entries for the poster competition, all of which were of a very high stand- Annual Pieta House Darkness into ard. Congratulations to the organising committee on such a successful event. (See Light 5k Walk/Run commencing at page 18-19 for full details) 4.15am on May 10. I am sure most I also addressed the OHN Section annual conference, which was held in Dublin in of you know that Pieta House pro- early April. The theme was ‘Occupational Health – Empowering through knowledge vides an excellent free, therapeutic and expertise’. Once again, it was an excellent day with really good speakers. I have approach to people who are in sui- to commend the Section officers for their time and effort in organising the event and the cidal distress and those who engage very interesting presentations. More details on this conference will appear in the June issue. in self-harm. The event will take The above conferences are examples of events that are organised by our sec- place in locations nationwide –for tion officers. I would encourage you all to affiliate with your appropriate section, those attending ADC there will be get involved and support these excellent educational opportunities which all carry an event in Kilkenny so an early start will have to be made! You can visit CEUs. These occasions are great opportunities for networking and meeting col- http://dil.pieta.ie to enrol. leagues across the country with the same interests. It is also important to attend your local branch meetings – check the Diary page or log on to www.inmo.ie for details of upcoming events/meetings. World Café event Ittd a en ed a World Café Event organ- Titanic Centre Belfast ised on behalf of the Irish Association The first all-Ireland Conference on ‘Delivering Safer Care’ was held at the Titanic Centre of Directors of Nursing and Midwifery. in Belfast in March. The conference was a North/South initiative hosted by the Pub- Also in attendance was Dr Siobhan lic Health Agency (Health and Social Care Forum) and other partners. It was the first O’Halloran, chief nursing officer and all-Ireland conference on patient safety and quality improvement and there was an nursing representatives from major excellent line up of speakers. The event acted as a showcase for quality improvement hospitals, the HSE and third-level insti- and patient safety initiatives from both sides of the border. With more than 300 del- tutions. It was a very interesting event egates in attendance, the conference gave an opportunity to healthcare workers where we explored issues in relation to present their quality initiatives and posters. I never cease to be amazed at the to our professions. I await with interest amount of time and effort people put into projects and I am very proud to be part the feedback from the event and was of a service where the staff are truly interested in providing high-quality, safe care. delighted to attend on your behalf. Get in touch You can contact me at the INMO headquarters at Tel: 01 6640 600, through the president’s corner on www.inmo.ie or by email to: [email protected]
WIN May 2014 Vol 22 Iss 4 51 INMO / RCM NI All Ireland Midwifery Conference Thursday, 16th October 2014 Crowne Plaza Hotel, Santry, Dublin 9 OUTLINE OF CONFERENCE
Morning Session:
Welcome Address
• Pregnancy Pathways Case Analysis Systems Analysis
Refreshments, Trade Exhibition and Poster Walk
• Concurrent Workshops
1. Mindfulness For Midwives 2. Human Tra cking 3. Breaking Bad News 4. Enabling Disclosure
Lunch and Trade Exhibition
Afternoon Session:
• Concurrent Workshops repeated as Morning Session
• Optimising Birth Case Analysis Systems Analysis
‘Pregnancy Pathways’ ‘Pregnancy Closing Address Poster Competition Award, Final Draws and Close of Conference
For further information on the conference, including the Poster Competition and Trade Exhibition, please contact Jean Carroll on 01 6640648 or email: [email protected].
A4 Programme Midwives Oct 2014.indd 1 18/02/2014 16:29:11 Celebrating midwives The International Day of the Midwife will provide an opportunity for the profession to refocus on the Millennium Development Goals
During the latter years of the 1980s many midwifery associations proposed the idea of celebrating midwives and midwifery internationally. As a result, the International Confederation of Midwives (ICM) decided to designate May 5 as the International Day of the Midwife and cel- ebrated it for the first time in 1992. For the past 22 years on May 5, mid- wives around the world think about their work and their global colleagues. occur in low resource countries, with wifery associations worldwide raise They celebrate their achievements and Sub-Saharan Africa bearing the biggest awareness of the centrality of their con- remember how much still needs to be burden. tribution to global health. They organise accomplished. As 2015 nears, midwives When maternal mortality rates are high, concerts, marches and rallies, as well as are particularly focused on the Millennium neonatal mortality rates are also a cause workshops and conferences in celebration Development Goals (MDGs), which relate for concern. Infant mortality has declined of the profession. to pregnant women and their newborns. considerably but neonatal mortality rates Last year, the ICM and the United There are eight international develop- have not improved. Many women in Nations Population Fund issued a joint ment goals, which were established in developing countries do not have access statement reiterating their commitment 2000, to be achieved by 2015 following to midwives or any healthcare profes- to strengthening midwifery. The Inter- the adoption of the UN Millennium Decla- sional during pregnancy, birth and the national Federation of Gynecology and ration. They are: postpartum period. Obstetrics (FIGO) also released a state- • To eradicate extreme poverty and hunger In 2010, the Global Strategy for Wom- ment recognising that midwives are • To achieve universal primary education en’s and Children’s Health stated that an crucial in ‘the fight against maternal and • To promote gender equality and extra 3.5 million healthcare workers were newborn morbidity and mortality’ . empower women required to ensure improved health for Each year in Ireland, the Essence of Mid- • To reduce child mortality rates women and their newborns. The World wifery Care Conference, hosted by the • To improve maternal health Health Organization (WHO) in 2005 had Coombe Women and Infants University • To combat HIV/AIDS, malaria and other identified that an additional 334,000 mid- Hospital, has been the main focus for mid- diseases wives would be needed in the years to wifery celebrations. This year, the Coombe, • To ensure environmental sustainability 2015. WHO recommends a ratio of one in partnership with the Nursing and Mid- • To develop a global partnership for midwife for every 175 women. Many would wifery Board of Ireland (NMBI) will host development. argue that such a ratio is inadequate, but the conference on May 1. All of these goals are inextricably linked. some countries, such as Rwanda, have only In the lead up to May 5, the NMBI will However, the fourth and fifth goals are one midwife per 8,600 births. hold the first Midwives Week to mark the of particular importance for midwives. Considering these figures, it is not sur- recognition, in Ireland, of midwifery as a Maternal mortality has declined signifi- prising to find that since 2009 the ICM separate profession. The theme is ‘Promot- cantly since 1990. However, more than has used the slogan ‘The world needs ing Safe Care for Mother and Baby’ and it 300,000 women die each year as a result midwives now more than ever’ for the runs from April 28 to May 2. of complications associated with child- International Day of the Midwife. Each Mary Higgins is the international officer of the INMO birth. Ninety-nine percent of these deaths year for the event, midwives and mid- Midwives Section
WIN May 2014 Vol 22 Iss 4 53 Letter
Take a look at Cuan Mhuire: An open letter from Sr Consilio Every nurse and midwife reading these words is only too aware of the pressures Sr Consilio Fitzgerald that exist; the cuts in staffing, the enormous Sr Consilio was born Eileen Fitzgerald and grew up on a farm on the Cork/Kerry border. She was loss of knowledge and experience arising educated in Knockaclarig Primary School and at the Convent of Mercy, Abbeyfeale, Co Limerick. from retirements and the effects of the cut- After completing her leaving certificate she qualified as a nurse in the North Infirmary in Cork. She backs on patients and the living standards then entered the Order of Mercy in Athy and is still a member of that community. Some years later, of those within the profession. I also have Sr Consilio returned to Cork, this time to St Finbar’s Hospital where she qualified as a midwife. to say that, while the experience of working While working in St Vincent’s Hospital in Athy, Sr Consilio came in contact with many ‘road men’. As abroad can be very helpful, especially in the she got to know them she decided that someday she would have a place that they could call home. early stages of one’s career, it is deeply pain- It was in 1966, in an old dairy in the Convent of Mercy in Athy, that the first Cuan Mhuire was born. For ful to see so many of our graduates leaving Sr Consilio this was the first seed on a journey of development leading to the establishment of nationwide the country when there is such a need for centres for people with addiction problems. Her achievements in the past 48 years are truly amazing. them within our health system. Her first residential centre in Athy, has been followed over the years by the opening of Cuan Mhuire The leadership within the professions, Centres at Bruree, Co Limerick, Newry, Co Down, Coolarne, Co Galway and Farnanes, Co Cork. In from the directors of nursing in our hospi- addition, Sr Consilio has opened a number of transition houses at Gardiner Street, Dublin, Galway City, Limerick City and Ballybay, Co Monaghan - Anne Boland, Cuan Mhuire tals right across to new forms of leadership in team-based specialties, is aware of the Cuan Mhuire is independent of the State That is why at Cuan Mhuire we have importance of maintaining morale and and has a very distinct ethos; one that is great affection, regard and respect for focus in these difficult times. Of course, wholly inclusive and which continues to our nurses and try to support them every there are also opportunities for exercis- take its inspiration from our name ‘Cuan way we can. We try to be flexible because ing leadership and responsibility which Mhuire’ or ‘Harbour of Mary’. Our Blessed I know myself the kinds of pressures that weren’t there when I was a young nurse. Lady was the mentor and never failing sup- can arise when nurses are trying to juggle Good leaders will always be able to exercise port of so many outstanding women who all kinds of different roles while still main- wise leadership, based not on control but founded religious nursing orders which taining the very highest standards of care. on example, especially by empowering and laid down the infrastructure of our hospital Cuan Mhuire is always in need of good by supporting colleagues, some of whom and health services. These women invested nurses: young nurses who instinctively may be under pressures of different kinds. their lives, and so much of their creativity empathise with our values and those nurses As a profession, we hold the wider and commitment, delivering the very high- who are considering retiring and want to health system together. We, with our est standards of nursing care, while always put all their experience to work in an envi- medical and consultant colleagues, are, in continuing to innovate, both in terms of ronment in which it would be truly valued. fact, also bringing into being a whole new technology and also training. I explained to your president that I health system in a particularly testing time. We in Cuan Mhuire continue this tradi- wanted to reach out to all of you who live So, political leaders have a responsibility to tion. Our work began supporting those within the hinterland of our major centres: respect the profession, to listen to what the who had lost everything through addic- Athy; Limerick; Galway; Cork; and Newry. profession is saying and to uphold those tion in one location in Athy. Today, our You are welcome to call into our centres at values at the core of our ethos. internationally accredited and ISO certi- any time, whether just for a visit, or out of Cuan Mhuire fied services embrace the whole Island. curiosity or perhaps there is a friend or a For us in Cuan Mhuire, good nursing Our core mission remains the same. member of your family that you feel might care is the beating heart of all that we Each of our main centres is located in need help. Equally, there may be some of do. We are the largest Tier 4 provider of extensive grounds which are thera- you doing research; we have our own two- addiction-related services across the peutic and nurture self-reliance. Our year, full-time diploma in counselling and Island with five major centres in Athy, professional care is focused on the whole we actively support applied research. Limerick, Galway, Cork and Newry. We of the person, on their physical, emotional, I would like to think that Cuan Mhuire deliver well over half the detox and resi- spiritual and psychological wellness, as all is a microcosm of our country, with all of dential rehabilitation services across the of these dimensions are inextricably bound its difficulties and challenges, but one in country. Most of our referrals come from together. which the person with the least is the most the families of our residents. For the most Our residents will always remember valued and in which the profession of nurs- part, there is no ‘selection’ in our admis- ‘their’ nurse, not alone for their professional ing is valued as it truly should be. Every day sions – in some of our houses upward of care but also for accompanying them on is new in Cuan Mhuire and everyday brings 50% are homeless. Over and above spe- their journey to living independent lives. opportunities for those of us to work here cialised care, for example in detox, the Isn’t that just an extraordinarily fulfilling to continue to give a lived example of what single most important need is for good, ‘calling’? Cuan Mhuire is, of course, a calling Cuan Mhuire is all about. pro-active nursing care. for all of us who work here. - Sr Consilio Fitzgerald
WIN May 2014 Vol 22 Iss 4 55 Offaly Branch News
INMO The Whitworth Building, North Brunswick Street, Dublin 7 email: [email protected] Tel:01 6640600
Branch Officers Latest news The Offaly Branch has had a busy year with the implementation of the Had- INMO first vice president/ dington Road Agreement. Many staff who were in acting posts for years have Branch secretary been regularised and all senior staff nurses are now being paid accordingly. Several new nurses have joined the Branch and many active members have attended the basic representative training and are putting that training to good use in the workplace. The new officers, elected this year, look forward to attending the ADC in May. These are difficult times for nurses and midwives but when we keep up to date with what is happening at branch level and support one another in every way, the burden is shared and the load is lighter. We welcome both new and current members to our meetings. Geraldine Talty [email protected] Industrial relations update • Midland Regional Hospital, Tullamore (MRHT) The INMO has been representing staff in MRHT. The hospital is severely under- Chairperson staffed with nursing numbers falling from 410 whole time equivalents in 2009 to 347 at present, despite a rise in activity of 25-30% in the same period. After several meetings with management, it has now been agreed that long-term agency lines will be converted; an increase in nurse staffing in the ED on night duty has been approved; and temporary contracts have been extended by six months with business cases submitted for permanent appointment. The INMO is also seeking that management directly employ nurses on a temporary basis, rather than agency use, to cover maternity leave. There are approximately 20-25 nurses on maternity leave at any one time and direct employment would be far Patricia Marteinsson more cost effective. [email protected] • Regional Centre of Nursing and Midwifery Education The INMO is making representation on behalf of the nurse tutors in the Regional Vice chairperson Centre of Nursing and Midwifery Education in the midlands with regard to the removal of paid breaks which came about following the revision of rosters under the HRA. Staff had been in receipt of a 30-minute paid lunch break since the centre opened in 1998. This change will result in staff working an additional four hours as opposed to one and a half hours weekly, under Haddington Road. • PHN/CRGNs PHN and CRGN members in the midlands have alerted the INMO to a number of workplace issues including the introduction of new documentation without consultation and agreement; increasing workloads; weekend working and mile- Ann Davis age. The INMO is in discussions with management to address these issues. [email protected] • Agency nurses The INMO has referred claims to the Rights Commissioner Service on behalf of a Treasurer number of agency nurses employed through Nurse on Call, seeking the pay- ment of location and qualification allowances. Such allowances are payable to directly employed nurses working in specialist locations and the INMO is arguing that agency nurses are entitled to equal treatment under the Agency Workers legislation.
Branch workplaces and areas covered • Midland Regional Hospital, Tullamore • Community nursing units • Riada House, Tullamore • Midoc Services • Triest House, Portarlington • Tanyard Anna Marie Dunne Resource Centre, Tullamore • Muiriosa Foundation, Tullamore • Agency nurses [email protected] • PHNs • OHNs • Community nurses • GP practice nurses
56 WIN May 2014 Vol 22 Iss 4 Student focus Procedural review Student and new graduate officer Dean Flanagan updates readers on dispute developments and explains some legal procedures The INMO continues to argue matters relating to student nurse pay and condi- What happens at a conciliation conference? tions. As there was no agreement during Conciliation is a voluntary process in which the parties of a dispute agree to avail of a neutral direct discussions with the HSE, three and impartial third party to assist them in resolving their differences. The Labour Relations issues were referred to the Labour Rela- Commission provides a conciliation service by making available industrial relations officers tions Commission (LRC). These issues are: of the Commission to chair ‘conciliation conferences’.These officers are referred to as • Application of incremental credit for the ‘conciliation officers’. Conciliation conferences are basically an extension of the process of 36-week clinical placement in the final year direct negotiations, with an independent chairperson present to steer the discussions and • E ffects of the introduction of a 39-hour explore possible avenues of settlement in a non-prejudicial fashion. Participation in the week on the rate of pay conciliation process is voluntary, and so too are the outcomes. Solutions are reached only by • Payment for a period post-qualification consensus, whether by negotiation and agreements facilitated between the parties themselves, pre-registration (circa six weeks). or by the parties agreeing to settlement terms proposed by the conciliation officer. A conciliation conference on these matters was held on April 2 at the LRC. Protected disclosures of information A resolution was not reached and a five- An employee may seek redress if they feel that they have been subjected to detrimental week adjournment was agreed after which treatment in relation to any aspect of their employment as a result of reporting a concern via the parties will reconvene. The INMO protected disclosure. In addition, employees are not liable for damages as a consequence of would like to thank the student nurses making a protected disclosure. The exception is where an employee has made a report that and midwives who took time to attend they could reasonably have known to be false. and speak at the hearing. If you would also like to be involved when we reconvene, patients. The preceptor’s registration is at risk with the procedures outlined in the leg- please email me: [email protected] if you are unsafe. Perhaps in your reflective islation it will be treated as a ‘protected For an explanation of what happens at diary explore your feelings of eagerness to disclosure’ – see box above for details. conciliation conferences please see the top pursue practice early in your placement. Its purpose is to facilitate employees to box above. Speak with your preceptor and in the make protected disclosures in good faith Student seat on Executive Council meantime learn all the aspects of the theory to an authorised person, where they have Congratulations to Darren O’Cearuill and the evidence about the skill or prac- reasonable grounds for believing that the who was elected as the student represent- tice that you wish to undertake. Show your health or welfare of patients/clients or the ative on Executive Council for 2014-2016. preceptor by discussion and your knowledge, public may be put at risk, or where there Darren is in his first year of nursing studies that you are safe to carry out this task. Your is waste of public funds or legal obliga- and will be a great benefit to the Execu- eagerness to practise and to fulfil your out- tions are not being met, so that the matter tive, voicing the concerns of students on comes in this practice placement is great, but can be investigated. placements and in college. remember it is over a number of weeks and Employees who do not wish to make a Also commiserations to the other two you are still in the learning phase working protected disclosure can make a ‘good faith candidates, Evelyn Farrelly and Kate Fin- towards being a skilled, qualified practitioner. report’. Good faith reports made to the infor- namore, and congratulations on terrific Patient safety first mation officer will be referred to the relevant campaigns run by all three nominees. Kate Lately we have heard many media reports HSE officer for investigation. The informa- and Evelyn will represent their branches at regarding whistleblowing, but as a student tion officer will not disclose the identity the ADC. are you aware of how it affects you? of the employee making the good faith Question of the month Section 103 of the Health Act 2007, came report where the employee so instructs. I am a student nurse on Placement 2 and I into operation on March 1, 2009, and pro- More information can be found on feel my preceptor won’t let me do anything vides for the making of protected disclosures www.patientsafetyfirst.ie Always feel clinical? by health service employees. If an employee free to email me ([email protected]) Remember that your mentor is respon- reports a workplace concern in good faith or contact your regional INMO office if you sible for you, your safety and the safety of and on reasonable grounds in accordance have any concerns.
WIN May 2014 Vol 22 Iss 4 57 Clinical Focus Continuing education and moving points in medicine
Continuing Education Module 21: Brain disease Diabetes and alcohol
Clair Naughton outlines the issues of alcohol use in those with diabetes and discusses the potential risks of hypoglycaemia and how to avoid them
Enjoying a drink is part of Irish culture, birthdays, weddings, body weight and family history of diabetes was not examined.3 funerals or celebrating the start of the weekend. Irish people find Regular drinking increases the risk of acute and chronic pan- many good reasons to enjoy a drink. So, is drinking alcohol off creatitis. 70% of cases of chronic pancreatitis are due to long term limits for people with diabetes? The happy answer to that ques- heavy drinking. 50% of people who have chronic pancreatitis go tion is no. The majority of people with diabetes can continue to on to develop diabetes.4 enjoy drinking alcohol, but they do need to be aware of the effect Role of the liver in maintaining blood glucose concentration that alcohol may have on their blood glucose levels in order that In order to understand the potential risks associated with they can drink safely. drinking alcohol with diabetes, it is important to have some Diabetes mellitus insight into how the body maintains normal blood glucose levels Diabetes mellitus is characterised by chronically raised blood and the vital role that the liver plays in this. glucose levels caused by an absolute or relative lack of the hor- In the fasting state the body has two major mechanisms for mone insulin. In type 1 diabetes insulin is not being produced by maintaining blood glucose levels. The first is the breakdown of the pancreas, it is caused by an auto-immune destruction of the glycogen (glycogenolysis) and the second is the production of insulin producing beta-cells in the pancreas. It usually presents in glucose or gluconeogenesis. Glycogen is stored in the tissues childhood or early adulthood and it is treated with diet, exercise particularly the liver. It serves as the first line of defence against and insulin injections. hypoglycaemia as it is broken down into glucose and is secreted In type 2 diabetes there is insufficient insulin or ‘resistance’ to by the liver into the blood to maintain normal blood glucose the action of insulin. Family history of diabetes, being overweight levels. Glycogen stores may be depleted in someone with type and having a sedentary lifestyle are major risk factors for the 1 diabetes particularly if they have repeated episodes of hypo- development of this type of diabetes.1 glycaemia. Gluconeogenesis also occurs primarily in the liver Diabetes and alcohol: How much is too much and it involves the formation of glucose from non-carbohydrate The recommended alcohol intake for people with diabetes is sources. the same as for the general population. As 90-95% of alcohol is metabolised in the liver it shuts down • Men: No more than 17 standard drinks per week the process of gluconeogenesis and thus the bodies second line • Women: No more than 11 standard drinks per week of defence against hypoglycaemia. Therefore, alcohol tends to • Do not consume more than five standard drinks in one sitting. increase the risk of hypoglycaemia by impairing hepatic glucose • Allow at least two alcohol free days a week release.5 • One standard drink = Hypoglycaemia > Half a pint of larger In patients with diabetes treated with insulin, alcohol has > Standard pub measure of a spirit been implicated in up to one-fifth of hospital attendances with > Small glass of wine (125mls).2 hypoglycaemia.6 Consistently drinking alcohol to excess has been linked with Hypoglycaemia can have serious even life-threatening conse- high blood pressure and obesity which are risk factors for type quences. The brain can only utilise glucose as an energy source 2 diabetes. unlike other tissues that can switch from oxidation of glucose to There is some evidence to suggest that a moderate alcohol non-glucose fuels. Therefore the brain is dependent on a con- intake may have a protective effect against the development tinuous supply of glucose from the circulation to maintain its of type 2 diabetes. Some studies show a U-shaped relationship metabolism and function. If the continuous supply of glucose is between alcohol intake and the risk of diabetes demonstrat- interrupted for even a few minutes it can lead to central nervous ing a higher risk of developing diabetes with both low and high system dysfunction.1 For this reason the body employs multiple intakes of alcohol and a lower risk with a moderate intake of alco- mechanisms to prevent hypoglycaemia. The first response to hol. These protective effects require further evaluation however hypoglycaemia is the release of counter-regulatory hormones and the evidence is not strong enough to advocate that teeto- and secondly the body generates a specific set of symptoms. tallers take up drinking alcohol. Also the interaction between These symptoms consist of autonomic symptoms (anxiety, alcohol intake and other risk factors for type 2 diabetes such as palpitations, hunger, sweating, irritability and tremor) and neuro- This healthcare professional education is sponsored by Lundbeck Ireland Ltd. Lundbeck Ireland Ltd has had no editorial oversight of the final content Clinical Focus
Table 1: Tips for patients with diabetes to reduce risk of alcohol • Never drink on an empty stomach: Food can affect the rate of alcohol absorption. Starchy carbohydrate should be taken before alcohol. Initially the carbohydrate in the alcohol will cause the blood glucose to rise, but very soon the alcohol will lower the blood glucose level (by impairing hepatic glucose release). Therefore it is necessary to eat more carbohydrate when consuming alcohol rather than less to prevent hypoglycaemia • Always eat carbohydrate before going to bed: As the liver breaks down alcohol it will impair the hepatic glucose release. Due to the effects of alcohol the person may not wake up in response to the symptoms of hypoglycaemia. This is dangerous, particularly if they are sleeping alone. It is essential that the blood glucose is checked and starchy carbohydrate is taken before bed to ensure the blood glucose is maintained overnight • More frequent blood glucose checks: Patients should be advised to monitor their blood glucose levels more frequently when socialising to monitor the effect of the alcohol. Always check blood glucose level before going to sleep. Physical activity such as dancing will also increase the risk of hypoglycaemia on a night out • Carr y identification: Patients should be advised to carry ID saying they have diabetes and tell the people they are socialising with that they have diabetes • Carr y carbohydrate: Patients should be advised to carry carbohydrate so they have a convenient source of sugar if needed • A void binge drinking: It is not appropriate for anyone to binge drink. Any more than five standard drinks on one night is considered binge drinking • Discuss with diabetes team: Some patients may require an insulin adjustment or an increase in their carbohydrate intake the day after drinking alcohol as the increased risk of hypoglycaemia can continue the next day. Patients should monitor the effect alcohol has on their blood glucose level and discuss it with their diabetes team so that they learn to drink alcohol safely glycopenic symptoms (dizziness, tingling, blurred vision, difficulty • Alcohol can increase the risk of nocturnal hypoglycaemia or concentrating and faintness). Counter-regulatory hormones hypoglycaemia the following day by impairing hepatic glucose are released at a plasma glucose threshold of 3.5mmol/l, symp- release.4 toms of hypoglycaemia occur at a plasma glucose threshold of Other factors influencing hypoglycaemia include the person’s 3.0mmols/l and cognitive function deteriorates when plasma glu- glycaemic control at the time, recent exercise, insulin absorption, cose falls below 2.7mmols/l.7 alcohol in relation to food intake and the duration of diabetes. Who is at risk of hypoglycaemia Glucagon hypokit, which is used to treat severe hypoglycaemia, Not everyone with diabetes is at risk of hypoglycaemia. Hypo- only works when the liver has glycogen stores. It will therefore glycaemia is a common side-effect of all insulins and certain not work to treat hypoglycaemia caused by drinking too much drugs used in the treatment of type 2 diabetes called sulphonylu- alcohol. It is essential that people with diabetes are aware of the reas which stimulate insulin secretion. Drugs in the sulphonylurea risks of hypoglycaemia following alcohol consumption to ensure category include Diamicron and Amaryl. Hypoglycaemia caused they maintain their margin of safety. If patients are aware of the by sulphonylureas can be prolonged and severe. The hypoglycae- periods where they are most likely to be at risk of hypoglycaemia, mia effect of insulin and sulphonylureas can be exacerbated by it will enable them to be proactive by adjusting their carbohy- the simultaneous ingestion of alcohol.1 drate intake or insulin dose accordingly. Patients on insulin therapy and sulphonylureas should be edu- Conclusion cated by their health care professional about the potential side Alcohol is part of everyday life for many people. Used sensibly effects of hypoglycaemia, including causes, treatment and avoid- it can be enjoyable. It is essential however for patients with diabe- ance. They should also be advised to carry carbohydrate with tes who are at risk of hypoglycaemia – that is those being treated them, ie. glucose sweets if they need to treat a hypoglycaemia with insulin or those on sulphonylureas – know of the potential episode when they are away from home. risks of hypoglycaemia and how to avoid them in order so that Alcohol and the risk of hypoglycaemia they can enjoy alcohol safely and maintain their margin of safety. Alcohol may be associated with hypoglycaemia in a variety of Clair Naughton is a regional development officer in the North West region with ways: Diabetes Ireland • Alcohol consumption can cause cognitive impairment affecting References a persons ability to detect the warning symptoms of hypogly- 1. Williams G, Pickup J. Handbook of Diabetes third Edition UK Blackwell Publishing Ltd 2004 caemia. If they are under the influence of alcohol they may not 2. HSE Dublin. Health A-Z Alcohol. HSE website 2013. Available from http://www.hse.ie/go/ take corrective action to prevent the plasma glucose falling alcohol/ 3. Alromaihi D, Zielke J, Bhan A. Challenges of Type 2 Diabetes in patients with alcohol further such as taking carbohydrate therefore will not prevent dependence. Clinical Diabetes (2012) Vol 30 No 3 neuroglycopenia 4. www.drinkaware.co.uk 5. Emanuele N, Swade T, Emanuele MA. Consequences of alcohol use in Diabetics. Alcohol • Alcohol has been shown to blunt the bodies hormonal coun- Health and research world (1998) Vol 22 No 3 ter-regulatory response to hypoglycaemia 6. Ricardson T, Thomas P, Weiss M, Kerr D. Day after the night before. Influence of evening • Third parties may mistake the symptoms of hypoglycaemia for alcohol on risk of hypoglycaemia in patients with Type 1 Diabetes. Diabetes Care (2005) Vol 28 No 7 Pg 1801-1802 symptoms of intoxication, which may have potential health or 7. Bolli GB. Mechanism, treatment and prevention of hypoglycaemia unawareness in Type even legal consequences for the individual 1 Diabetes International Diabetes Monitor 1998 Vol 10(1)
60 WIN May 2014 Vol 22 Iss 4 10th Annual Telephone Triage Nurses Section Conference
Portlaoise Heritage Hotel, Wednesday, October 1, 2014
For further details please contact Jean Carroll, Section Officer, at [email protected]
Win a luxurious 5-star midweek getaway for two at Fota Island Resort, Cork
Together with the World of Irish Nursing and Midwifery, Fota Island Resort, a 5-star treasure, nestled in the heart of a peaceful island, surrounded by gorgeous scenery just eight miles from Cork city and host to the Irish Open 2014, is offering one lucky reader the chance to win a luxurious midweek getaway for themselves and a guest. Escape your daily midweek routine and retreat to Fota Island Resort where the stunning scenic backdrop provides a glorious destination for a memorable stay. Enjoy two nights’ accommodation in one of the hotel’s elegant and sophisticated bedrooms and awake each morning to a freshly prepared full Irish breakfast. During your stay, sit back and relax in The Amber Lounge with Afternoon Tea as you savour a delicious delicacy of sweet and savory treats, including gourmet sandwiches, freshly baked scones, delicate pastries, and desserts. Looking for an indulgent treat during your stay? Escape to the tranquil world of serenity at Fota Island Spa, a world-class destination spa, with an outstanding range of products, treatments and facilities including a fully equipped and spacious gym, a large indoor heated swimming pool and relaxation area. You’ll also receive complimentary passes to the Hydrotherapy Suite ensuring you leave feeling rested, rejuvenated and ready to face the world again. For a preview, visit www.fotaisland.ie Terms and Conditions: Prize available to take from Sunday-Thursday only. Prize is subject to availability and non-transferable. Prize is not valid during Christmas, Easter or Bank Holidays The winner of the April giveaway to the Step House Hotel is: Sabrina Howe, Co Kilkenny ! To enter send this form to: Fota Island Resort, MedMedia Ltd, 25 Adelaide St, Dun Laoghaire, Co Dublin. Closing Date: May 12, 2014. Winner will be announced in next issue. Name: Phone no: Address: If the walls could talk Consultant psychiatrist Jim Lucey’s discuss our feelings for anyone affected room at St Patrick’s University Hospital has by mental illness. a high ceiling, a wooden desk, a bookcase Among those who readers will accom- and several comfortable chairs. It does not pany on the road from distress to recovery have the iconic psychiatrist’s couch. in the book are: Prof Lucey believes as long as it is a • L iam – “Sooner or later I will be found out space where people feel able to talk and and I just dread to think what is going to feel that someone has listened and heard happen then” them, then it is a space of value. The peo- • A lyson – “People never trust you again ple who come into his room all have if they find out that you have mental heartfelt stories to tell and Prof Lucey health problems. If I lose that trust I’ll hopes that sharing some of these stories never get it back. People will always look will help to demystify the hidden zone at me differently”. that exists between psychiatrists and their Prof Lucey has chosen the method of patients. clinical storytelling and the very personal In My Room contains 15 real stories that and heartfelt stories are allowed to speak Prof Lucey has heard during his 25 years for themselves. Clinical notes explaining of working with patients with various the disorders, syndromes or treatments mental illnesses towards recovery. It gives mentioned in each person’s story can be voice to mental health experiences in a found at the back of the book. way that everyone can identify with. – Tara Horan
Prof Lucey has taken the bold step of of recovery emerges from each one. In My Room by Jim Lucey is published by Gill & telling these stories to the general public One in four people in Ireland is affected Macmillan, ISBN 9780717159512, E16.99. The in order to break down barriers between by a mental health problem, yet there author’s earnings from sales of this book will be patients with mental illness and health- is still a reluctance to talk about it. The given to the St Patrick’s Mental Health Foundation, Ireland in support of the Walk in My Shoes campaign care professionals. While the patient author hopes his book will highlight the to raise funds for services for young people with stories are diverse, the common theme importance of finding time and space to mental health problems !
Across Down 1 2 3 4 5 6 7 1. Mandible. (3) 1. You may be chosen for this citizens’ Solutions to April crossword: 3. Ing redient used as a sweetener by one who duty in court. (4,7) Across:1. House of Lords 7. Hem selects actors? (6,5) 2. Nomad. (8) 8 9 9. Owls 10. Smooth 11. Belt 8. Haphazard. (6) 3. Undo a lock with this garment. (5) 15. Orion 16. Sear 18. Noted 9. Young horse.(8) 4. Oh dirty kind of gland! (4-3) 21. Twice 22. Alloy 23. Recur 10 11 12 10. How a snake might enter unnoticed. (5) 5. Small mammal. (5) 24. Echo 25. Swill 26. Stops 29. Lady 33. Temple 34. Oust 11. Cries.(5) 6. Profited. (6) 13 14 36. Elm 37. Pre-eclampsia 13. Harness straps. (5) 7. Scrap of material. (3) Down: 1. Haw 2. Ursa Major 15. Plantar wart. (7) 12. Yielded (11) 15 16 17 3. Ease 4. Flora 5. Outdo 6. Shoe 16. Pirate. (7) 13. Took part in a speed competition. (5) 8. Motorcyclist 9. Out of the blue 18 20. Work this when baking bread. (5) 14. Laziness. (5) 12. Finish 13. Anger 14. Manic 19 20 21. English composer who might have given 17. Flour ished, was widely present. (8) 17. Eclair 19. Terms 20. Daisy it large! (5) 18. Fantastic, dreamlike. (7) 27. These 28. Pupil 30. Damp 21 22 23 23. Hunting dog. (5) 19. African country, capital Kampala. (6) 31. Beam 32. Hops 35. Sea 24. Declare or proclaim. (8) 22. Part of a golf course off the fairway. (5) 24 25 25. Type of arachnid. (6) 23. Joyful. (5) The winner of the 26. Ar ea in the Mojave Desert, the lowest and 24. Also. (3) driest place in North America. (5,6) May crossword is: 26 27 27. It’s a failure, whichever way you view it. (3) John Brosnan Cashel, Co Tipperary Name: The prize will go to the first all correct entry opened. Address: Closing date: Tuesday, May 20, 2014 Post your entry to: Crossword Competition, The World of Irish Nursing, MedMedia Publications, 25 Adelaide Street, Dun Laoghaire, Co Dublin Finance
M ON E Y MATTERS
Your questions answered by Ivan Ahern Guide to new sick pay entitlements From March 31, 2014, changes to public sector sick pay entitlements formally com- menced for the majority of public sector months, in a rolling four-year period then What can you do to protect your income? employees. So what does this mean to you may be granted paid sick leave. If you You can protect against these changes you? exceed the 183 days limit, you will not be with the INMO Income Protection Scheme. Previously, as a public sector employee, entitled to any sick pay. The Scheme has made provision for the you were typically entitled to 26 weeks The second look-back period is to new arrangements. This means it will now (six months) full pay and 26 weeks (six determine whether full pay or half pay cater for shorter-term claims that are likely months) half pay in a rolling four-year applies. If you have less than 183 days, to become more frequent due to the new period. Once you have accumulated 52 your sick leave record is reviewed over arrangements. weeks (12 months) of illness in total over the previous 12 months from the current The main aim of the Scheme is to pro- a four-year period, you would have been date of absence to determine the rate of tect you against the additional financial taken off the payroll altogether. sick pay. If you have less than 92 days in strain that unexpected illness can bring Now that the new arrangements are in the last 12 months you may be paid full with it. The Scheme provides you with a place, you have access to paid sick leave pay up to 92 days, with half pay for up to a benefit of up to 75% of your annual salary of 13 weeks (92 days) at full pay in a year further 91 days, subject to an overall limit less any other income – eg. early retire- followed by 13 weeks (91 days) at half pay, of 183 days of paid sick leave in a rolling ment pension, temporary rehabilitation subject to a maximum of 26 weeks (183 four-year period. remuneration and/or State illness benefit days) in a rolling four-year period. The When you have exceeded 183 days – to which you may be entitled. rolling four-year period is calculated by you may receive temporary rehabilitation This benefit means invaluable peace of working backwards from the latest date of remuneration for a further 18 months (548 mind that you can continue to pay your sick leave absence. days). Temporary rehabilitation remunera- regular outgoings such as mortgage, The only exception is in the case of ‘criti- tion was previously known as ‘pension groceries, school expenses etc, while you cal Illness’ where paid sick leave will be rate of pay’. This will be based on the focus on recovering. With the new public provided for six months full pay in a year accrued pension had the member actually sector sick pay arrangements, it’s more followed by six months at half pay in a retired on grounds of ill health. important than ever to protect your rolling four-year period. The total maximum period of sick pay income. If you go out on sick leave, your sick including temporary rehabilitation remu- To find out more about the INMO leave will be reviewed over a rolling four- neration is two years. Income Protection Scheme, please con- year period to determine if (a) you have How might this affect you? tact Cornmarket at Tel: 01-4708084 or log access to paid sick leave and (b) if you do, Example: Mary fell ill in 2011 and on to www.cornmarket.ie what rate of paid sick leave applies to you. couldn’t work for 28 days. Then in 2013 Ivan Ahern, Director, Cornmarket Group Financial There are two ‘look-back periods’. The she broke her leg and couldn’t work for Services Ltd. first look-back period is to determine a further 92 days. If Mary falls ill in 2014, Cornmarket Group Financial Services Ltd. is regulated whether or not you receive sick pay. If under the new sick pay arrangements, she by the Central Bank of Ireland. A member of the Irish Life Group Ltd. Telephone calls may be recorded for quality the paid sick leave that you have already would only be entitled to 63 days at half control and training purposes. Irish Life Assurance plc is received does not exceed 183 days, ie. six pay. regulated by the Central Bank of Ireland
64 WIN M ay 2014 Vol 22 Iss 4 Update
Top accolades awarded to Irish healthcare professionals More than 400 people from the world of Irish healthcare attended this year’s Irish Healthcare Centre Awards, which were held recently in the Royal Marine Hotel, Dun Laoghaire, Dublin. The event celebrated the achieve- ments of all the finalists who were judged by a panel of some of the lead- ing professionals in their fields, including Elizabeth Adams, INMO director of pro- fessional development. These judges worked tirelessly to review an enormous amount of applications before they determined the winners. The awards were organised by CMG Events and hosted by broadcaster, Marty Pictured at the Irish Healthcare Awards were (l-r): Elizabeth Adams, INMO director of professional development; Mary Jacob; Dr Mary Higgins; Mary Brosnan; Dr Rhona Mahony; Geraldine Maguire; Fionnuala Byrne; Mary Coffey; Sinéad Whelan. Ian Carter, director of acute hos- Curran; and Máire Tarpey, all from the National Maternity Hospital, Holles Street - winner of the Maternity Hospital of the pitals at the HSE, gave a warm keynote Year; and broadcaster Marty Whelan address and referred to the excellent and diverse work being done in healthcare. A total of 20 awards were presented and many winners told stories of their team’s perseverance and determination in providing services. Others had exciting stories of new research and innovation, the potential positive health impacts that could be delivered and how winning an award was going to help them continue with their work. The Healthcare Person of the Year, Dr Kathy McLoughlin, the national end-of-life audit and review co-ordinator at the Irish Hospice Foundation, spoke passionately about developments in palliative and hos- pice care. She talked about how this type Pictured at the Irish Healthcare Awards were (l-r): Elizabeth Adams, INMO director of professional development; David of care needs to improve, and how it is Lane, Dr John Aidan Horan and Dr Declan J O’Brien, who won the Rehabilitation Centre of the Year Award for Arbour House – Drug & Alcohol Services; and broadcaster Marty Whelan currently changing for the better. Test to evaluate heart attacks earlier Know your heart RATE A new diagnostic test, which could will subsequently be adopted at other key A new campaign, ‘Know Your Heart RATE’, reduce the time to diagnose and treat cardiology centres throughout Ireland. was launched last month to empower and heart attacks by several hours, is to be The preferred biomarker for identifying educate patients on heart rate manage- piloted at the Mater Misericordiae Uni- suspected heart attacks is cardiac tro- ment so they can lead longer, better lives. versity and Mater Private hospitals in ponin, a protein found in the heart muscle. The campaign, by Servier Laboratories, fol- Dublin. Many patients who visit the emergency lowed recent research which revealed that The ARCHITECT STAT High Sensitive department with a suspected heart attack heart rate in cardiology patients is regularly Troponin-I (hsTnl) test, developed by currently have blood samples drawn with measured by healthcare professionals but Abbott, has shown promising prelimi- troponin tests upon admission, after six not actively treated. nary results, which suggest that it may hours, and then potentially 12 hours later, The ‘RATE’ campaign aims to educate help improve the diagnosis and progno- before a diagnosis may be made. healthcare professionals to optimise heart sis of patients presenting with symptoms For patients having a heart attack, early failure patient care, with a focus on the of a heart attack. This could be particu- diagnosis is crucial. The new hsTnI test can importance of heart rate management in larly beneficial for women, who are often measure very low levels of the protein, heart failure and coronary artery disease under-diagnosed. which allows doctors to evaluate whether patients. This campaign can then be shared It is anticipated that after being imple- or not patients are having a heart attack with patients to encourage self-care to mented in the Mater hospitals, the test within two to four hours. improve lives.
WIN May 2014 Vol 22 Iss 4 65 Diary
Monday 9 May Nurse/Midwife Education INMO Library Opening Hours Section meeting, INMO HQ. Saturday 10 Contact: [email protected] or Emotional Wellbeing Tel: 01 6640648 Conference, Focusing on May 2014 challenges surrounding Tuesday 10 Monday-Thursday:8.30am-4.45pm pregnancy and childbirth. The National Care of the Older Friday: 8.30am-4pm Gresham Hotel, Dublin. 9am. Person Section Conference. Contact: Emma Clarke Portlaoise Heritage Hotel. [email protected] or Contact: [email protected] or Tel: 01 Tel: 086 8174429/01 8430930 6640648 Wednesday 14 Saturday 14 For further information on the library and Student nurse/midwife Section PHN Section meeting, 11am, its services, please contact: meeting,11am, INMO HQ. INMO HQ. Contact: [email protected] Tel: 01-6640-625/614 Fax: 01-661 5012, Email: [email protected] Contact: [email protected] or Tel: 01 6640648 Friday 16 Clinical Nurse/Midwife Annual nurses’ golf outing, Managers Section Tools for Safe New INMO Membership Fees 2014 Rathdowney Golf Club, Laois. Practice workshop, INMO HQ. ILGU swipe cards required. Contact: [email protected] or Tel: 01 A Registered nurse €299 Cost: E50 inc. tea/coffee 6640648 (Including temporary nurses in prolonged employment) on arrival, golf and dinner. Saturday 21 B Short-time/Relief €228 Contact: 086 8461600, email: Midwives Section meeting, 2pm, This fee applies only to nurses who provide very short term [email protected] venue TBC in Galway. Contact: relief duties (ie. holiday or sick duty relief) or send name, club and entry [email protected] or Tel: 01 6640648 C Private nursing homes €228 fee to Antoinette Kelly c/o Rathdowney Golf Club, Co Laois Thursday 26 D Affiliate members €116 ODN Section meeting, 7pm, Working (employed in universities & IT institutes) Wednesday 21 INMO HQ. Contact: [email protected] E Associate members €75 Telephone Triage Nurses or Tel: 01 6640648 Not working Section meeting, 11am, INMO € HQ. Cardiac Update. Contact: F Retired associate members 25 [email protected] or Tel: 01 6640648 August G Student nurse members No Fee Thursday 22 Friday 8 Retired Nurses Section Retired Nurses Section Visit to Dail Eireann. 11.30am Visit to Aras an Uachtarain. CICIAMS XIX World Congress Meeting point: Dail, Kildare 2.30pm. Meeting at main Comite International Catholique des Infirmieres Street entrance at 11.15am gate, Chesterfield Avenue. et Assistantes Medico Sociales Contact: Margaret Nordell, Onsite parking available if car [email protected] registration details are provided Hosted by the Catholic Nurses Guild of Ireland to Margaret Nordell in advance. Tuesday 27 Contact: [email protected] Protecting Family Life: the role and responsibilities of nurses Infant loss and bereavement and midwives study day by the Foundation for Infant Loss Training, Cassidy September All Hallows College, Drumcondra, Dublin 9 Hotel, Dublin. For midwives, students, neonatal professionals, Wednesday 3 23-26 September 2014 and children’s nurses and RNID Section meeting, INMO HQ. See: www.catholicnurses.ie or contact Marie at Tel: 0876142064 doctors. Tel: 0044 7564450348 or Contact: [email protected] or Tel: 01 email: [email protected] 6640648 Wednesday 28 Saturday 6 ICN calls for abstracts for 2015 OHN Section meeting, 1pm, Midwives Section meeting, conference in Korea INMO HQ. Contact: [email protected] Limerick regional maternity or Tel: 01 6640648 hospital. Contact: [email protected] The International Council of or Tel: 01 6640648 Nurses (ICN) has called for Thursday 29 abstracts for its conference in Third Level Student Health Thursday 11 Retired Section meeting, 11am, Seoul, Korea, on June 19-23, Nurses Section meeting, 11am, 2015. With the theme ‘Global INMO HQ. Update on diabetes/ INMO HQ. Contact: [email protected] or Tel: 01 6640648 Citizen, Global Nursing’, the conference will provide a platform for obesity management. Contact: the dissemination of nursing knowledge and leadership across [email protected] or Tel: 01 6640648 Saturday 13 specialities, cultures and countries. PHN Section meeting, 11am INMO HQ. Contact: [email protected] To share your ideas, research and expertise on how to provide June or Tel: 01 6640648 quality care, improve populations’ equity and access to health care, Monday 22 or contribute to further advance nursing knowledge and practice, Wednesday 4 Nurse Midwife Education you are invited to submit an abstract. To submit an abstract online to RNID Section meeting, INMO HQ. Section meeting, INMO HQ. https://b-com.mci-group.com/AbstractSubmission/ICN2015.aspx Contact: [email protected] or Contact: [email protected] or Tel: 01 For more information see www.icn2015.com Tel: 01 6640648 6640648
66 WIN May 2014 Vol 22 Iss 4 10th Annual Telephone Triage Nurses Section Conference
Portlaoise Heritage Hotel, Wednesday, October 1, 2014
For further details please contact Jean Carroll, Section Officer, at [email protected]
National Care of the Older Person Section Conference
Tuesday, June 10, 2014 Portlaoise Heritage Hotel, Portlaoise Town Centre
Topics to be covered will include, amongst others: • Advanced Care Directive and End of Life Care • Advocacy – Intense Listening – real advocacy for people living with dementia • Diabetes in the Older Person • Depression in the Older Person • HIQA – Risk Assessments • Communication & Understanding
All members working in the Care of the Older Person setting are encouraged to attend this conference.
The cost to attend for INMO members is €65 and for non-members is €100 Contact: Jean Carroll, INMO Section Officer, Tel: 01 664 0648 or by email at [email protected] for further details or log onto www.inmo.ie
INMO_CareOlderPerson_Feb14_Full.indd 1 Mar/20/14 12:10 PM
Welcome to the programme: Leading in Uncertain Times
Do you want to build the leadership capacity of your organisation? Then this is the programme for you!
This booklet provides information for Directors of Nursing & Midwifery/Directors of Services and Education about the Leading in Uncertain Times Programme, programme content, online resources and outcomes.
This programme has d been esigned for S taff N urses, Midwives, and Clinical Nurse and M idwife Managers 1&2.
Building leadership capacity and developing leaders’ is capabilities a key focus of the National Leadership and Innovation Centre (NLIC), Office for the Nursing and Midwifery Service The Director HSE. Leading in Uncertain Times Programme is an innovative leadership development course which can be delivered by staff in your own organisation and is supported and funded by the NLIC.
If you are interested in having facilitators trained to deliver this programme, please contact: Email: [email protected] Mobile no: 0860470863 Email: [email protected] Mobile no: 0879087482
The Leading in Uncertain Times Trainer (facilitator) programme and ongoing support is funded and facilitated by the National Leadership and Innovation Centre, Office for the Nursing and Midwifery Services Director, HSE. Visit The Centre’s website:www.hse.ie/go/nurseandmidwifeleadership Email: [email protected]; Telephone: +353 61 483301
What is the Leading in Uncertain Times Programme?
Clinical Strategy and Programmes Division
Leading in Uncertain Times Progamme booklet FA4.indd 1 10/04/2014 15:00
Welcome to the programme: Leading in Uncertain Times
Do you want to build the leadership capacity of your organisation? Then this is the programme for you!
This booklet provides information for Directors of Nursing & Midwifery/Directors of Services and Education about the Leading in Uncertain Times Programme, programme content, online resources and outcomes.
This programme has d been esigned for S taff N urses, Midwives, and Clinical Nurse and M idwife Managers 1&2.
Building leadership capacity and developing leaders’ is capabilities a key focus of the National Leadership and Innovation Centre (NLIC), Office for the Nursing and Midwifery Service The Director HSE. Leading in Uncertain Times Programme is an innovative leadership development course which can be delivered by staff in your own organisation and is supported and funded by the NLIC.
If you are interested in having facilitators trained to deliver this programme, please contact: Email: [email protected] Mobile no: 0860470863 Email: [email protected] Mobile no: 0879087482
The Leading in Uncertain Times Trainer (facilitator) programme and ongoing support is funded and facilitated by the National Leadership and Innovation Centre, Office for the Nursing and Midwifery Services Director, HSE. Visit The Centre’s website:www.hse.ie/go/nurseandmidwifeleadership Email: [email protected]; Telephone: +353 61 483301
What is the Leading in Uncertain Times Programme?
This programme consists of two components:
1. A 2 day programme forfacilitators: Train the Trainer Programme. 2. Facilitators then deliver a 2 day programme, The Leading in Uncertain Times Participant Programme, for staff nurses, midwives and clinicalnurse and midwife managers 1&2.
1. Leading in Uncertain Times -‐ Train the Trainer (facilitator) Programme This programme recognises that trainee facilitators bring a rich mix of previous experience and knowledge andare experienced in adult learning. It is desirable that one facilitator brings experience from a service area, for example a clinical manager and the second facilitator brings experience from the area of training/practice development. During this 2 day programme the trainee facilitators will: • develop their facilitation skills by reflecting on their current style of facilitation and previousence experi • explore new concepts and perspectives and apply this learning to situations related to delivering the programme
2. Leading in Uncertain Times Participant Programme This 2 day programme is for staff nurses, midwives and clinical nurse and midwife managers 1&2. The programme includes the following key areas: 1. Self Management 2. Problem solving 3. Leadership 4. Challenges in Healthcare
The programme involves three core blended learning supports: 1. Online Resources 2. Face to Face workshops 3. Implementing a Quality Improvement Initiative
Participants and Facilitatorsneed to register onwww.hseland.ie to gain access to thep rogramme content and material.
How will your staff and organisation benefit? Programme participants are required to complete a ‘Quality Improvement Project’ which addresses a work priority in their service area. This priority can be linked to the National Standards for Safer Better Healthcare (2012) and to the Standards in the Quality Framework for Mental Health Services (2007) thus promoting high quality patient care.
Directors as Implementation Sponsors: your commitment Directors of Nursing & Midwifery/Director of Services and Education are the implementation sponsor for the Leading in Uncertain Times initiative. There is a commitment to release two facilitators from your organisation for the 2 day Facilitator Preparation Programme. Facilitators are required to deliver the two Leading in Uncertain Times programmes annually in your organisation. The implementation sponsor agrees with the ,facilitator the mode of delivery for the participants attending.
2 Clinical Strategy and Programmes Division 2
Leading in Uncertain Times Progamme booklet FA4.indd 2 10/04/2014 15:00
The following Organisational Pathway outlines your organisation’s commitment to the programme. This pathway outlines the responsibilities of each stakeholder involved to ensure the organization is prepared.
Leading in Uncertain Times Organisational Pathway
Implementation Sponsor -‐ Director of Nur sing Midwifery/Director & of Services/Education
• Facilitator to discuss and agree with the Director of Nursing & Midwifery/Director of Services/Education dates for facilitating the 2 Day Leading inUncertain Ti mes Programme (Mode A.B.C) in the ir organisation • Facilitator to register their own detailswww.hseland.ie via if not already registered • Only one facilitator enters the details of each programme i.e. dates, mode of delivery if programme is co-‐facilitated (both facilitators will have access to view the Quality Improvement Projectswww.hseland.ie online )
Organisational Readiness • Organisational Readiness Checklist tobe completed by the Director ofNursing & Midwifery/Director of Services • A copy to be su bmitted to the Natio nal Leadership and Innova tion Centre for Nursing & Midwifery
Programme Release for participants to attend Mode A, B, C, This table gives you an outline of the different modes of delivery and the commitment to release a minimum and maximum number of staff depending on which mode is being undertaken by the participants Mode of Delivery Minimum/Maximum Number of participants attending Mode A-‐ Staff Nurses and Midwives Min. of 8 participants to a Max. 20 participants Mode B -‐ Clinical Nurse and Midwife Managers 1&2 Min. of 8 participants to a Max. of 20 participants
Mode C -‐ Day 1 is delivered to both groups together. Day 2 is Min. of 10 participants to a Max. of 20 participants. It delivered with staff nurses and midwives in one group and clinical is important to note that it is desirable to have equity nurse and midwife managers1&2 in another group. The two days of places between these two groups i.e. 5 Staff are designed to be delivered consecutively if service ermit needs p Nurse/Midwives and 5 Clinical Nurse/Midwife this, however if this is not possible, it is desirable that the interval Managers 1&2 is not more than two weeks to maintain participants’ momentum.
Process to attend programme in organization • Facilitator(s) toadvertise date, venue and informat ion onthe 2 Day Leading in Uncertain Times Program me (Mode A.B.C.) • Facilitator(s) to confirm with participant(s) their place onthe program me • Facilitator to inform participant 2 weeks prior to commencement of programme of accessing precourse material online via www.hseland.ie Completion of Programme • Facilitator delivers 2 day LiUT Programme and completes evaluation of programme online via www.hseland .ie
Support Structures The National Leadership and Innovation Centre for Nursing & Midwifery will facilitate programme upd ates for facilitators as required. Online forum support via www.hseland.ie is available between facilitators
Post Programme Delivery: 6-‐8 Weeks • Participant and Line Manager meet to review progress and discuss outcomes of the Quality Improvement Project • Participant will articulate the outcomes of the Quality Improvement Project online via www.hseland.ie • Certificate of Achievement will be generated by participant via www.hseland.ie on confirmation of completion of the Quality Improvement Project to the Line Manager and Facilitator.
3
Clinical Strategy and Programmes Division 3
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The following programme pathway outlines the process of engagement for the facilitator, participant and line managers. This pathway shows the sequence of actions for nurses and midwives to apply to participate in the programme and the ment commit they will make to change an aspect of their . practice
Leading in Uncertain Times Programme Pathway
Implementation Sponsor: Director of Nursing and Midwifery/Director of Services/Education
Application process to attend the programme • Dates, venue and information of the Leading in Uncertain Times(LIUT) programme is advertised by facilitator. • Participant applies to their line manager to undertake the 2 day LiUT programme. • Line manager informs the facilitator of the number of applicants attending. • Mode of programme i.e. Mode A,B,C is agreed by the implementation sponsor and facilitator. • Facilitator registers their details on www.hseland.ie if not already registered. If it is co-‐facilitated only one facilitator enters the details of each programme i.e. dates and mode of delivery. Both facilitators will have access to view the Quality Improvement Projects via: www.hseland.ie
Meeting between line manager and participant • Participant’s leadership development needs and goals are identified. • Work priorities in the service area are discussed and how one of these priorities can be underpinned/linked to the National Standards for Safer BetterHealthcare or to theStandards in the Quality Framework for Mental Health Services is exploredwww.hiqa.ie or www.mhcirl.ie • Participant will give assurance of their commitment to undertake and complete all aspects of the LiUT programme and access prerequisite programme material online at: www.hseland.ie 2 weeks prior to commencement.
Within 24 hours of completing the programme • Participant and line manager agree the title of the Quality Improvement Project with the impact and desired outcomes clearly documented. • Participant registers their details, their title of the Quality Improvement Projectetes and compl the programme evaluation online at:www.hseland.ie
Steps to consider when deciding on a Quality Improvement Project Step 1 Consider a Quality Improvement Project that will: • Have the greatest impact on the patient/service user experience. • Improve the delivery of care in the participant’s service area. • Reduce/remove waste. Step 2 Utilise SMART – Specific, Measurable, Achievable, Realistic and Timely
At the end 6-‐8 of weeks • Participant and line manager review progress and discuss impact of Quality Improvement Project. • Participant will articulate the impact of the Quality Improvement Project onlinewww.hseland.ie via: Certificate of Achievement will be generated by participant via nfirmation www.hseland.ie on co of completion of the Quality Improvement Project to their line manager and facilitator
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Clinical Strategy and Programmes Division 4
Leading in Uncertain Times Progamme booklet FA4.indd 4 10/04/2014 15:01