PARTISAN!

Florence Waterlow writes this in her own capacity and not representing the QNMU, Queensland Health or any of Queensland’s Hospital and Health Services in anyway. The views are entirely her own and do not reflect those of her employer. The author is a nurse and hence does not have a practical experience of midwifery, but would welcome contributions and corrections from militant midwife readers [contact]

As of 3rd June, the QNMU has voted to engage in protected industrial action starting on June 9th.

At the 2024 State election, the Queensland Nursing and Midwifery Union (QNMU) presented a declaration to the major parties to commit to maintaining nation-leading wages for Queensland nurses. The Liberal National Party (LNP) signed this and committed to do such in their election manifesto. This commitment was dead on arrival, to the surprise of no one. Once elected, the LNP government refused to seriously negotiate or present an offer up until after the expiry of the Enterprise Bargaining Agreement (EBA) 11 between the QNMU and Queensland Health.

The end of EBA 11 is significant as it is the first of many expiring public sector EBAs in 2025 including high school teachers, school cleaners and classroom assistants. Collectively, a large proportion of the working class in Queensland faces the possibility of taking strike action. Bold action by the nurses and midwives could provide other workers with the confidence to engage in the class struggle around the new EBAs.

The leadership of the QNMU stressed the importance of maintaining nation-leading pay for all nurses and midwives in Queensland. The reasoning for this focus was argued in terms of the very real staffing crisis faced throughout Queensland Health, with difficulty in hiring and retaining sufficient staff. A high number of nurses and midwives leave the profession after being overworked, underpaid and burnt out. While this line of reasoning is correct, and it is right for the QNMU to fight for wages higher than any of the current agreements in force in Australia, the parochial framing limits the ability of nurses and midwives to fight for maximal gains and obscures the collective struggle of nurses across Australia let alone internationally. Victorian Nurses-Midwives recently won a 28.4% wage increase from a historically low base. While historically Queensland Nurses and Midwives have earned more than their Victorian counterparts, there is no reason why they should not fight for a similar of greater pay rise. The QNMU has chosen to use this as a way of skewering the LNP on a broken election promise, which could well be effective but implicitly endorses the regressive practice of competition across state lines.

The QNMU also fought for improvements in conditions and entitlements, especially around issues of reproductive and gender justice. This included protecting reproductive leave which is crucial for nurses dealing with endometriosis, infertility and other burdens that predominantly fall on women. Sadly, there was no move to include trans healthcare into this package or as its own entitlement. They also sought to tackle the internal gender pay gap, with male nurses and midwives tending to earn more than their female counterparts, as well as an over-representation of male nurses and midwives in leadership positions. Crucially, the QNMU pointed out the sexist discrepancy where Queensland public sector workers in male dominated roles receive double time pay for night shifts, whereas nurses receive only time and a half. Combating these sexist divisions is necessary to fight patriarchy and foster increased unity among workers.

Another major plank of the QNMU’s position was increasing support for staff in leadership positions. There was advocacy for increased support for Nurse Unit Managers and Midwife Unit Managers to decrease their unenviable workloads. It was also proposed that shift Team Leaders be exempted from having a patient load. These measures are both necessary and vital, however they were not matched by targeted policies to improve the conditions enrolled nurses, graduate registered nurses and other junior staff members. This has the potential to disunify nurses and midwives of differing levels of seniority as well as dampen enthusiasm and engagement in the Union for nurses entering the profession who are those with the most to lose with a weak EBA.

Before the first offer, the government stated nurses and midwives would be held to the draconian pay cap of a mere 8% increase over three years. The initial offer presented by the government in May, while slightly more generous than the pay cap, was both late and derisory. 66% of nurses and midwives would be below nation-leading wages in 2028. The government removed conditions entrenched in EBA 11, stating they were covered by existing industrial relations legislation – which the LNP can decimate in parliament. No increased offer was presented regarding night shifts, and many other planks of the QNMU campaign were ignored. The rights of workers in multi-disciplinary teams to have pay parity were also undermined, which could lead to an up to $18,000 pay cut for a small minority of nurses and midwives in highly specialised roles.

In an unprecedented act of bad faith, the government threatened not to pay back pay in the period between the EBAs if EBA 12 was not agreed to by the end of May with no industrial action taking place. This was a cynical, yet legal, attempt to rush the membership into signing the deal based on fear. The QNMU held a wave of online meetings on the back of face-to-face consultations across the different regions of the state and held a text survey on the proposed deal, which was defiantly rejected. The membership responded overwhelmingly positively to the proposal of protected industrial action. Nurses and midwives currently stand unbowed against the government’s threats in an act of unity and strength.

Queensland Health refused to submit a second offer before the deadline set by the union triggering an official ballot on industrial action, which opened on Thursday the 22nd of May and closed on Monday the 26th of May. The ballot proposed the following twelve gradually escalating actions – which would be implemented while maintaining nurses and midwives’ professional obligations to patient safety.

1. Ban on providing information on who is participating in industrial action to management,
2. Partial ban on sending electronic communications unless they display Union content.
3. Partial work ban unless nurses can wear union t-shirts, badges and stickers.
4. Partial work ban unless workers can display union materials in the work areas.
5. A partial work ban on providing non-clinical care including meeting attendance, answering phones, stripping and making beds, cleaning, emptying bins, non-urgent patient transfers and moving equipment and beds.
6. A ban on collecting and recording data that is not required by law.
7. Strict adherence to rest breaks and lunch breaks in full except in emergencies.
8. Ban on redeployment of staff from one ward to another.
9. An Overtime ban.
10. 30 min stoppages at a maximum of once a day to carry out Union activity.
11. Refusing to open beds and closing beds to ensure strict adherence to nurse- to- patient ratios (frequently exceeded at great risk to patient safety).
12. An Unlimited number of work stoppages lasting up to 12 hours.

The list of actions has the potential to cause mass disruption without endangering patient safety. It will be a major source of embarrassment for the government, with nurses and midwives being two of the most well-respected jobs in Australia. On a deeper level, this could highlight the mission creep and widening of the role of nurses and midwives which functions as a constant speed up and intensification of work.

Historically, nursing attended largely to basic patient care tasks. The clinical, educational, managerial, leadership, research and administrative components of the role have progressively increased without a reciprocal rise in real wages. The nursing scope of practice constantly expands into what was once the preserve of doctors. The increasingly technical nature of nursing has many positives with improved patient centred care, increased control of the healthcare process by nurses and the up-skilling of a largely women-dominated workforce. The more basic patient care and housekeeping tasks such as restocking supplies, cleaning, stripping beds, bed making and other non-skilled and semi-skilled work has remained largely the province of nurses with a comparatively small number of assistants in nursing, paid students, cleaners, administrative officers and orderlies unable to fill gap.

One nursing day (or night) can often involve labour as disparate as preparing and administering twelve different intravenous drugs, collecting lunch trays from the kitchen, de-escalating violent patients, titrating blood thinners, cleaning human excrement off the bathroom floor, being urinated on, training students, repeatedly redirecting lost dementia, being punched by the same patients, navigating the intricacies of the Mental Health Act and producing reams of documentation, all while advising often very junior medical officers on the right course of action for deteriorating patients.

This is especially the case during night shifts where even in the top two Brisbane tertiary hospitals only a skeletal crew of doctors remain in place or on call overnight. The fact this work can be paid as little as $41.50 an hour is a crime against the working class. The Princess Alexandria Hospital, Queensland’s second largest hospital, has a 25% turnover rate of nurses per year which is reflective across the industry. This illustrates high levels of burn out and low levels of job satisfaction. Nurses and midwives are expected to perform a skilled role and unskilled role at the same time while being paid substantially less than skilled male dominated jobs in the public sector. Abstaining from non-clinical duties can highlight the multiyear uncompensated intensification of work by making the invisible gendered labour visible in the form of overflowing bins, beds remaining unmade, phone calls unanswered and data unavailable to management.

In a characteristically opportunist turn, Queensland Health produced a second offer the day after the poll opened on Friday the 23rd of May 6pm imploring staff to contact the Union in favour of this deal. The deal proposed increasing overtime for shift workers from time and a half to double. This would only impact level 2 to 7 registered nurses (Rns), leaving graduate RNs and enrolled nurses high and dry for no discernible reason. The email also offered permanent night shifts and unsubstantiated claim of increasing support for leadership roles. Despite misleading wording, the deal did not increase the additional wage offer and kept the door open for a reduction in entitlements and conditions. This could impact parental and reproductive leave which would be a devastating. The second offer was clearly a tactic to sow confusion and disunity during the ballot period. The fact, the email sent Friday evening was a cynical ploy to get the final word over the union. The QNMU almost immediately acknowledged the existence of the second offer, while continuing to urge members to vote yes in the protected industrial action ballot. The membership and the leadership saw through this amateurish tactic by the Government.

On May 27^th, the results were released, with 96.4% of those who voted favouring protected industrial action (turnout not reported). In a positive move, the Union decided not to reject send the 2nd offer provided by the government. The application for taking protected industrial action has now been approved by the Queensland Industrial Relations Commission and the union is preparing to give Queensland the statutory three-day warning prior to the start of the campaign.

Nurses and midwives working for Queensland Health have a Union density above 80% and they are incredibly angry and disillusioned with their employer as evidenced by the high rates of burnout and turnover. These workers are extremely well connected, with an almost infinite number of WhatsApp groups populated by passionate, capable and highly articulate workers. There is also a strong understanding amongst the workers that with society aging and getting sicker the public healthcare system is sleepwalking into collapse without major investment from the government.

While nurses and midwives have strengths there will be weaknesses that must be tackled for the industrial action to be successful. Socialists can point to the QNMU’s historical commitment to Laborism and collaboration with Queensland Health, the Queensland Industrial Relations Commission, and the Fair Work Commission as the root of the problem. The union has not balloted on Industrial action since the early 2000s, which correlates with Labor being mostly in power at the state level. Years of handshake agreements with management have undermined the capacity of the union to participate in openly hostile class struggle.

The institutional memory and culture of industrial action is almost lost to the current membership at a time when it is desperately needed. While socialist nurses should educate their colleagues on the union leaderships failings, we must focus on what can practically be done to make the industrial action an educative lesson in class struggle and a success story that can bolster the resistance of the whole working class. What is built will be the institutional knowledge and culture of the future and the fight will be a test of the resolve of the Labor loyalist leadership.

Practical material problems for the union must be considered for the success of the strike. Nursing and Midwifery being women-dominated presents the problem that many nurses have a disproportionate responsibility for social reproduction in the home. This impacts their ability to organise. The provision of childcare and meals could increase the bandwidth available for union activity by nurses and midwives. Participation is also extremely patchy, with many workplaces not having strong, loud and visible rank-and-file organising. The high union density masks the fact that many members join the union for the complementary public indemnity insurance which is a legal requirement of the registration and enrolment of nurses and midwives.

Hence, much of the membership is de-politicized and disconnected from union life. Many union representatives are dormant and there is a lack of communication with newer nurses on industrial relations who often don’t know what an EBA or Protected Industrial Action is. There is a fear that the union may struggle to communicate decisions to the membership around when and what to do in terms of industrial action. This is partially an outgrowth of the lack of internal democracy in the union. The recent internal elections only had one organised platform which fought a public campaign with the other platform producing no campaigning material sign of campaigning material the author could locate online or at work. Socialists and militant nurses and midwives play a role in finding solutions to these problems to build a Union that empowers its members to democratically wage class struggle against the bosses.