Sunday, November 27, 2011

value matters

There are many ways to value “things”.
Things might be worth 
  • what it cost to design/make/market and deliver them; 
  • what it cost to buy them; 
  • what we are prepared to pay for them; 
  • how much they have deteriorated or been superseded; or 
  • what someone is prepared to sell them for. 

All of these possible valuations will differ depending on such variables as how scarce they are; whether we can afford them, or how useful they might be in the long term.

Then there are things which might be precious simply because they mean a great deal to us.
Can we judge what a society values most by what it is prepared to pay for different assets and services? 
By this measure it seems the Occupy Movement has a reasonable axe to grind. 
Is a woman who is ludicrously rich because her father had the vision to dig holes in the ground really worth so much more than everyone else in the country? Is a woman who spends 120 hours a week doing piece work on a sewing machine really worth so much less?

Of course, our intangible values are more difficult to measure in terms of money.
Government budgets or even legal decisions can reveal something about what we value, but not everything.
We might quibble about the details, but we value the environment and pass laws to protect it for the future.
As a predominantly omnivorous nation, we have legislation reflecting our belief every animal deserves a clean life and a clean death.
We have many laws [perhaps too many] reflecting our belief that we should respect or care for each other, even strangers.
We have a free, universal health care system built on the notion that if we encounter someone in distress our first instinct is not to ask if they have insurance, but to ask what we must do to keep them alive.

We can walk into the emergency department of any hospital and see the values of doctors, nurses and allied health workers in action: A throng of people – washed and unwashed, whiney or stoic, weak or strong in character, victims of chance or those who are the causes of their own suffering – are all treated equally. For most people who work in medical fields, life itself has a greater value than the temptation to pass judgment.

No person can survive for long in any job that challenges their core values and convictions, or where they are under-appreciated. The few who are judgmental are statistical outliers, or jaded after years of working in a system that is not built on the values it should be.

The current campaign by Victorian nurses for better pay and fixed nurse:patient ratios is not driven by greed, it’s a reaction to the long term, ongoing neglect of the health system by governments whose budget priorities are out of sync with what I hope we value most as a society – life.
The value we place on life and its quality is not being pooh-poohed by nurses, but by those directly responsible for a scarcity of health resources.

Our reasonably free market economy is fuelled by demand; by the notion that when we value a resource this value will motivate others to provide it. We might think of democratic governments as entities we buy with votes, but it seems our democracy is a “free” market place where none of the usual rules apply. For example, 
  • We are ruled by an oligopoly, for there are few political brands to choose from and they are not very well distributed.
  • When the promises we buy are defective; when our governments let us down, we have no consumer affairs organisation which will refund the vote we paid.


The Baillieu government insists nurses cannot have pay rises unless they deliver an increase in productivity. 
If the question of nurses’ pay is nothing more than an exercise in sound budgeting, then it is fair to assess what government – the nurses’ bosses and business managers – are themselves contributing to productivity levels.

Would we expect printers to churn out magazines or books without paper or ink? Similarly, should we expect hospital staff to be productive when our hospitals do not have enough beds, or enough equipment to cope with demand? 

What equipment they do have is in a poor state of repair and in short supply.

When Mother Other was finally placed on a special emergency room cardiac bed – after three hours in a queue – absolutely none of the equipment needed was functioning, with some missing altogether. 
The Other herself once spent hours in agony experiencing a full blown heart attack in a hospital corridor. The corridor space was only available because she has connections. Such was the demand on resources that other, more life threatening cases were attended to first, on the understanding The Other would survive and could be helped once the attack was over.

These two situations did not arise because of industrial action, they arose at times when it was ‘business as usual’ in Victorian hospitals.

The Baillieu government claims the system has enough nurses; that some of the traditional nursing tasks could be handled by ancillary staff. Today, certificated PSAs strip, wash and disinfect every hospital bed then make it up with fresh sheets, after use and before a new patient takes over. In practical terms, what should nursing staff do when a patient soils themselves, or is bleeding profusely – press a buzzer and wait for a free PSA to arrive? 

If a patient’s head must be elevated to keep their airway open, who is the best person available to immediately prop up the head and provide jaw support? If a patient needs jaw support – which might mean physically lifting someone’s head and holding it in the correct position for an hour or more – how many patients should one nurse be expected to care for? Even with a one:to one nurse:patient ratio, where does the help come from if the bed of a jaw-support patient needs changing, or drugs must be fetched, or a doctor called?
A printing press uses floor space. Floor space is also required for storing paper and ink, for a guillotine to cut the paper to size, a place to store finished product before it is trimmed, and somewhere for a printer to stand or move backwards and forwards.

Similarly, in a hospital emergency department space is required for a bed, up to three or four nurses or doctors at a time for each bed, an equipment cart, privacy and more. But space is something in very short supply in hospitals.

If our economy requires an investment in resources to provide the services we need, it also requires incentives to attract workers into service industries. If someone chooses to become a nurse, what’s in it for them? What’s the reward at the end of an expensive university degree?

Under the 2010 award, these are the weekly wages of a Div 1 nurse with a 3 year degree:

Level 1
Pay point 1
Pay point 2
Pay point 3
Pay point 4
Pay point 5
Pay point 6
Pay point 7
Pay point 8

This makes an entry level rate of $35,000 rising to $44,000 over 8 years.

The average minimum graduate entry salaries [per annum] for other career paths are:

HR & Recruitment
IT & Communications
Trades & Services
 [Nov 2011]

Economists have long acknowledged that all wages or salaries contain a ‘transfer’ component. As an example, this means that someone who enjoys a great deal of job satisfaction in their current position would need an irresistible increase in salary to be lured away by a new employer.

Hospital staff – especially public hospital staff – deal every day with 
  • verbal abuse, 
  • threats of physical abuse, and 
  • real physical abuse. 

The small proportion of patients who are feral or aggressive might 
  • be suffering a psychosis over which they have no control, 
  • be under the influence of some very heavy duty drugs, 
  • feeling they need to compete for medical attention, or 
  • simply antisocial. 

Nursing staff often lift people far heavier than themselves, deal with unpleasant bodily functions, and accept responsibility for making life or death decisions all day every day. 

They deal with death, the grief of relatives and friends of patients, and their own grief. Theatre staff, and in particular recovery staff, are often punched or kicked by people coming out of an anaesthetic and desperate to remove tubes and lines from their face and arms. Some of them even lash out simply because they can [until someone calls their bluff].

The Baillieu government claims nurses were placing the welfare of patients at risk by closing beds; by excluding cases of elective surgery.
The system which has evolved for prioritising surgical cases is, in itself, an indication that the system is under-resourced.

Elective surgery is surgery that can safely be delayed for more than 24 hoursThe term ‘elective’ is used only to distinguish it from emergency surgery, which is required within 24 hours to save a life. 

Elective surgery does not mean that the surgery is optional – elective surgery is often life saving (for example removal of a tumour) or very important to a patient’s health and well-being (such as a hip replacement). It is also known as planned or booked surgery. Elective surgery can be postponed and, unfortunately, too often is postponed for far too long.

But there are different categories of elective surgery. What has not been made clear in the government's criticism of the nurses' industrial action is which category of elective surgery is on hold, and how often exceptions to these bans are being made.

Cat 1
Admission within 30 days desirable for a condition that has the potential to deteriorate quickly, to the point that it may become an emergency
Cat 2
Admission within 90 days desirable for a condition causing some pain, dysfunction or disability, but which is not likely to deteriorate quickly or become an emergency
Cat 3
Admission within 365 days for a condition causing minimal or no pain, dysfunction or disability, which is unlikely to deteriorate quickly and which does not have the potential to become an emergency

With the current state of affairs in our public hospitals, one in ten patients do not receive their surgery within the recommended time frame, and 3 quarters of these are people living in Qld, Vic and Tas. 
[The Tasmanian figures should not be surprising as even Hobart is classified as “Inner Regional” as it is so short of essential services - usually provided to Tasmanians by Victoria].
Nurse patient:ratios have an impact on these delays.
The Baillieu government has recently closed 100 hospital beds.
Victoria is struggling to hold on to paramedics.

Churn numbers relating specifically to nursing are hard to find, but a 2008 paper makes the following quite plain:

There is currently a severe shortage of experienced nurses in Australia, as in many other developed countries. This is considered to be the result of both decreasing enrolments in nursing education, and poor retention rates of those in the nursing workforce. Retention rates are generally thought to have worsened over recent years. There is also concern over the ageing of the nursing workforce since this will cause critical shortages in the future as greater proportions of nurses reach retirement age.

I do hear plenty of anecdotal evidence that a large number of nurses desert the hospital system within 6 months of graduating.

When it comes to government priorities, health, child protective services, aged care and education are all competing with everything from transport and other infrastructure to motor or horse racing for funds.

I am hopeful that the yartz will obtain continued support, and that Flinders St Station will be preserved and revitalised. I am also aware that as much as a couple of months in Europe would add to my quality of life, I have to sacrifice or postpone some things in order to pay for other priorities in my own life. 

When it comes to the wages of nurses, the usual government tactic of shifting the blame is not a very productive solution to a systemic problem. Blaming nurses or letting their "accounting value" further behind will do nothing to increase productivity.


  1. Some effort went into that, thanks. While I know nurses' pay is boosted by penalty rates etc, the base pay really is very poor and I am surprised at the low figures.

  2. The figures surprised me, Andrew. Nursing is a career I would not take on even if I thought I could.

  3. Damn, VERY damn fine writing there, FC!
    I have a long memory and I recall a certain David Davis (then in opposition) claiming that, months after the last bed closure action by nurses, the increased number of hospitals on by-pass was a direct result of the nurses union action....nothing to do with a lack of hospital beds or hospitals and the increased demand in winter from high numbers of elderly and ill.
    That ridiculous statement there and then summed up the loathing that man appears to hold for nurses - else we wouldn't be in this very situation today.

  4. TY Jayne.
    The older we get, and the more we remember of stupid politicians and stupid political decisions, the more we will be in need of medical treatment for stress-related illnesses, perhaps. Oh Bugga!

  5. I am speechless with rage whenever I have the misfortune to use the health 'system'. Not because of the staff, but because this most elemental of requirements for a healthy society, upon which so many other flow-ons depend, is treated like a poor relation when funding is handed out.

    There IS enough money to go round - it's just a matter of basic budgeting. If I don't have enough cash in my wallet when I go to the supermarket, the packet of TimTams stays on the shelf! Oooops, sorry! I'm preaching to the converted, aren't I??!!

  6. Yes, Red, I think we are on the same page [which might mean at the end of the document where the footnotes are set out in 5 point type!]