APNA 2015 National Conference – Brave to Bold – Welcome

officially welcome you all and kick off brave too bold the 2015 apna conference she began as a primary healthcare nurse and nurse manager and general practice she’s an accredited immune immunization provider and has recently moved into practice management Karen holds several committee and advisory group positions including the general practice round table the national immunization committee the Advisory Committee for safety and vaccine and participated in several advisory groups for the RCGP including the pandemic task force and the review of the pandemic flu kit the infection control standards and quality health records and I was talking to some of karen’s team yesterday I just want to get a sense of who karen is this incredibly talented woman and I was amazed to find out that she still is working in practice she keeps her skills up and someone told me and I’ve got to find out if this is true well no Karen you’re still working practice currently yep is it true that a little while ago you were doing data entry at your practice two days a week like sitting in a computer and doing data entry is that correct some time ago okay so she was sitting there doing data entry very qualified professional woman sitting at the computer because it needed to be done and someone said all I wonder if she can do you know immunizations and of course you qualified so Karen started doing the immunizations they went well wouldn’t we need someone to do the wound care obviously you know how to do the wound care can we get someone to do the health and welfare advice and we helped someone to you know manage chronic diseases Karen stepped up she did all of it and I guess the thing that really stood out for me karen is right now our country needs you to be doing what you’re trained and qualified to be doing you know we don’t need you sitting at a computer we need you keeping people out of hospitals am i right yes so that’s what we need you to be doing right now my friend ladies and gentlemen please welcome to the stage the most overqualified data entry operator in the world your apna president karen booth thank you everyone and before I begin I’d like to thank Luthor for that very warm welcome to country and on behalf of apna I too would like to recognize the traditional owners of the lands and seas that we are meeting on today I’d also like to pay my respects to elder’s past and present and I warmly welcome any Aboriginal and Torres Strait Islander people here with us today moving on good morning everyone and welcome to the Gold Coast this our seventh national conference where together we are making the step from brave too bold I extend a warm welcome to our dignitaries we welcome the Minister for health the Honourable miss susan lee and we appreciate the minister showing her support for primary health care nurses and being with us today in what probably could be considered the busiest week in parliament so minister welcome we work in the Commonwealth chief nurse dr Rosemarie Bryant chief nursing midwifery officer and we’re very much looking forward to rosemary sharing her story from brave to bold with us today there are a number of other dignitaries here from the Commonwealth Department of Health Karen cook and Alison Simpson are in the crowd somewhere welcome to you as well we are delighted to have attracted such a wonderful array of international and homegrown speakers who will contribute to the brave to bowl program over the next few days we’re very much looking forward to you sharing your stories your teaching and your knowledge about primary health care nursing and I welcome you all the theme for this year’s conference came from our app no strategic planning day where the board had reflected on the enormous growth and change and the development of our organization over the past two years and as well as significant developments in the role of primary health care sing and we could see the progression from the previous strategic plan which at the time apnar considered to be brave we looked at the increasing sophistication and the cutting-edge approach that apna has adopted and could see that that we were now indeed moving upwards from brave too bold primary health care nursing is one of the fastest growing areas of Nursing in Australia there are approximately 39 thousand nurses working in primary healthcare with more than 11,000 of those working in general practice we are seeing nurses moving from the tertiary hospital sector into primary health care nursing as they seek experience in

longer-term continuity of community-based health care I myself moved into general practice after years in emergency department pediatric ICU and then a brief stint as an academic and what we know is that these nurses like most of you here in the room bring a rich and high level of skill to the primary healthcare setting we are also seeing greater numbers of new graduate nurses choosing to make primary health care nursing their first career choice exposure to primary health care nursing correct in the curricula is improving and apna is connecting with students and working with universities to promote primary health care nursing as a viable and compelling career choice we know that nurses in general practice needs some additional reports support to ease into their new role and apnar is working developing that support the rise in the demand for nursing services is driven by the recognition and the benefits that nurses bring to the healthcare teams and the demand by health consumers for services provided by nurses and a greater options in health care choices these benefits include the adoption of cost-effective flexible and multidisciplinary approach to health care we know that one in two Australians has a chronic condition with one in four having at least two chronic conditions cardiovascular disease mental health and musculoskeletal conditions account for approximately twenty-five percent of the Australian health budget the number of Australians with dementia will reach almost 400,000 by 2020 and 900,000 by 2050 strong primary healthcare systems are ultimately the answer to Australia’s looming healthcare crisis yet these systems are under significant stress access to care is becoming increasingly problematic as demand rises and some practices many in rural areas are already having to close their lists two new patients forcing people to seek care in the more expensive emergency department in casually casualty based clinics how do we as a nation both contain and manage this whilst most importantly maintaining quality and safety of the care that’s being delivered the solution lies in primary healthcare delivered through general practice and other community-based services nurses are key to that upstream approach to healthcare that is good quality screening preventive care coordinated care to reduce the risk and morbidity that comes at a high cost to the patient to their family and to us as a country we know that chronic conditions are placing significant demand on our health resources and as primary care and primary care nurses are central to that response those 39,000 nurses that I mentioned earlier are spread across almost every local community in the country nurses are already well positioned as care innovators patient educators problem solvers and agents of connectivity and we all know that phrase the glue that hot that binds it all together nurses are highly respected group of health professionals there is a strong recognition that nurses are vital to the provision of high quality local accessible care that contributes to improved health care outcomes for their patient populations and reduction in hospital admissions there are nurses here today from every state and territory from the most remote to the inner city which reflects that we apna truly are a national organization you the nurses in this room are strong and capable workforce who will take back knowledge and skills that you’ve learned over the lect the next few days to your local communities I see this conference as the hub of innovation for primary

health care nurses in Australia we have also seen a sharp growth in the demand for primary health care nursing input into health committees and advisory groups not just in their local community but also at high state level and federal health committees we’ve seen a growth in the number of members supported by a pina leading the way and putting their hands up and utilizing their expertise but as evidenced by the large number of committees listed in our annual report this year and if you haven’t seen it I suggest that you seek a copy and and just and look we want to see more nurses moving from brave and pushing forward to be bold offer your skills and nursing view as we see these new only health care network setting up nurses know the practicalities of how health programs are implemented on the ground in their workplaces in their clinics and dealing with real people our patients and to see more nurses participating in that helicopter view of governance and sharing their knowledge at high-level health policy development we also wish to thank the minister and the Department of Health for the support they have shown investing in the current work of apna the nursing in general practice program to support the nursing workforce to deliver best practice high quality health care however we also know there is more work to be done I’m proud lead apna as our profile continues to evolve into a flexible and nimble organisation apna is the peak body representing nurses in primary healthcare and continues to port support the primary health care nursing workforce with high quality professional development advocacy and actively driving contemporary models of primary health care nursing Eppler will continue to focus forward and move from brave too bold to help achieve our vision of a healthy Australia through best practice primary health care nursing we wish you and enjoyable two days at our conference and we wish you all the best on your journey from brave too bold now I would very much like to welcome the minister of the Commonwealth minister for health the Honourable miss susan lee to the stage the minister has a very personal connection to nursing her mother is a nurse and we welcome you into our vault and you’re in a room full of nurses and you’re someone may attempt to mother you they do that in our previous meetings with the minister I was impressed with her willingness to listen and to consult please welcome the Honorable miss susan lee to the stage thank you very much indeed Karen and to you too Julie Ann your vice president to rosemary the Commonwealth chief nurse and midwifery officer who’ll be joining you shortly and to the participants particularly that have traveled from overseas it’s lovely to be here can I acknowledge the traditional owners and pay my respects to elder’s past and present and say that as Australia’s health minister I absolutely understand that the health of our first Australians is inextricably linked to their connection to country it’s just a few days since the treasurer delivered his and our this government’s second budget and only a few weeks since I announced some important initiatives to reform and update Medicare these initiatives are common sense they’re overdue they’re well supported by medical and health professions and in building a better Medicare system I want to see one that’s sustainable for the long term the latest intergenerational report from the Treasury predicted that Medicare would be the fastest growing element of government health spending income in coming decades in fact our health spending in Australia is growing much faster than that of other countries when I hadn’t been the health minister very long I met an earlier Health Minister Michael wooldridge and he said to me you know the average term of the health minister in Australia is about 20 months so if you want to get on and do something may as well hurry up so maybe

I need to be brave and bold I like the theme of your conference and and I very much like your comments i must say from the the nurses at the beginning i was very pleased that all the glasses were full i was a bit worried there was a couple of empty ones at the beginning but to capture I think what everyone said it was very much about you as nurses are here for the whole patient and the whole patient journey and as the minister and as the department and as the colleagues in the parliament and I always say ministers come and go but the system has to be robust and strong what we must do is make sure that we don’t hone in on different aspects of the system without seeing it as a whole and without realizing that patients don’t see it like that they get sick they go to a doctor they go to hospital they come back out maybe they go back in again they go back into general practice and so on and there’s all this sort of complicated different funding streams and two levels of government that manage it so we have got work to do and we have got improvements we can make we are taking a consensus approach I know that’s an overused word in politics but we don’t need opposition for the sake of it every one of us is a customer of the Australian health system and every one of us gains when our health system is working the best it can there’s no doubt that you as primary health care nurses will be important players in the changes that will follow the reform process as it unfolds so let’s look at some numbers in the last 10 years the number of nurses working in general practice has doubled more than 12,000 nurses now work in general practice and around two-thirds of practices employ at least one nurse practice nurse is now account for almost one in three nurses in primary care who total I’m told around 39,000 and primary care nurses in turn comprise well over one in eight of all nurses in health services in Australia universities have recognized these changes and shifted the focus on undergraduate nursing courses to include more content related to primary health care rather than acute care nursing the Australian Government has also for more than a decade recognized the potential of nurses to provide primary healthcare services in fact it was Tony Abbott as Minister for health who introduced the first Medicare items for services by nurses and they related to wound care and immunization that was in 2004 he later expanded the number of Medicare nurse items and extended the incentive scheme for GPS to employ nurses to hundreds more practices today the professional capacity of primary health care nurses is supported by the nursing in general practice program man edged by the government for the government by apner and the practice nurse incentive program which provides assistance for general practices and indigenous specific medical services to employ nurses and allied health professionals so notices are making a major contribution to primary health care and your role will only increase under the reforms that I have announced these reforms to Medicare are genuine and are aimed at improving the operation of Medicare and quality of health care for patients I’m determined to work hand-in-hand with health professionals and patients to ensure that Australians receive high-quality and appropriate care as efficiently as possible the three priority areas for reform are based on the feedback I received during months of consultation they reflect first and foremost the obvious need for our health system to adapt to modern patterns of ill health with chronic disease now the major problem we face chronic diseases like diabetes cardiovascular disease asthma cancer muscat musculoskeletal conditions and stroke can as you all know so well have a huge impact on sufferers and their families they make it hard to stay active in employment and in the community damaging prosperity at the household community and national level as a group chronic diseases are now the leading cause of illness disability and death in Australia the surge in the incidence of chronic disease has been a factor in pushing up the cost of Medicare which more than doubled from about ten billion dollars to about twenty billion dollars over the past decade the need to do better for patients with chronic and complex conditions is therefore a major theme of our Medicare reforms so first a review of the Medicare benefits schedule the review will be done by a task force led by the Dean of the Sydney Medical School professor bruce robinson currently the MBS has more than 5,500 services listed the review will eliminate out-of-date ineffective and even harmful procedures

and recommend ways to align services with contemporary clinical practice and evidence secondly an advisory group led by former am a president dr. Steve Hambleton will investigate options for better primary healthcare it will specifically look at better care for people with complex and chronic illness innovative care and funding models which recognize the ongoing needs of those patients better recognition and treatment of mental health conditions and greater connection between primary healthcare and hospital care thirdly the government will work with health professionals and consumer representatives to develop better rules on the use of Medicare in each reform area I will be looking for guidance and input from everyone who is active in the health environment I encourage abner and all of you here today to add your expertise to this process over the next few months I’ve asked for a report back on each of the three priority areas for action later this year I’m sure that as frontline service providers you understand exactly why change is needed we need better funding models for regular patients with chronic conditions it makes sense to explore a blended model of payment where perhaps the general practice receives a block of funding from the government to care for the particular patient but there is also some fee-for-service funding and this is not of course a new idea it’s already happening in general practices now to some extent primary healthcare must also become more relevant to the needs of current and future patients it has to be more effective in promoting health and preventing disease more coordinated with other health services more consistent in quality better targeted to groups at risk and more efficient at every level it should be heavily focused on keeping Australians well and out of hospital and aged care facilities should be there but Australians should be healthy and happy in their own homes for as long as possible you as skilled primary health care nurses will be crucial to achieving these goals now the other big reform that we are using to collectively reach these goals are our primary health networks it’s only a matter of weeks until the Medicare Locals transition to ph ends starting on july one ph ends will receive funding of approximately 900 million dollars from the government over three years they will concentrate on six key priority areas mental health Aboriginal and Torres Strait Islander health population health health workforce a health and aged care a key difference between primary health networks and Medicare Locals is that the primary health networks will focus on improving access to frontline services a little bit invisible behind the scenes working with general practice working with you working with all of the organizations that already exist in their population base not recreating what is already being done in general practice they will have GP lead clinical councils and community advisory committees to keep them focused on the needs of the communities within their boundaries a number of the consortium’s which have been selected to run the pH ends through a tender process include some of our more successful former Medicare Locals many of them harness skills and knowledge from a range of sources including allied health providers universities and even private health insurers the pH ends will work directly with GPS other primary health care providers secondary care providers hospitals and the broader community aligning the pH ends to the state local hospital networks will help to reduce this merry-go-round for patients with chronic or complex conditions between primary care and hospital treatment and while the pH ends will work at the local level we also need national and state level direction to enable us as a nation to turn around the growth in chronic disease and their risk factors work is currently underway to develop a new strategic framework for chronic conditions replacing the 2005 national strategy this new framework will recognize the links between national and state based chronic conditions strategies and will reflect shared views on priorities and how they should be addressed it will provide a modern policy model which can easily incorporate new evidence and will provide another opportunity to consider how to deliver co-ordinated integrated and multidisciplinary care we’re also developing a separate national strategy for tackling the epidemic of diabetes which is now estimated to contribute to about one in every ten deaths and likely to rise sharply in the future public consultation on the national diabetes strategy is about to end and we’re going to release the final strategy before the end of the year I was at a roundtable of allied health professionals recently and was told that we have the second highest

rate of diabetic amputations in the world which is an alarming statistic and one which I certainly don’t think we can accept your work force your involvement continues to grow both in terms of the number of nurses working in the area and the number of patients with or at risk of diabetes that you care for I should also note briefly that the government is continuing to support the popular mental health nurse incentive program in 2015 16 it will ensure service continuity for over 54,000 people with severe and persistent mental illness living in the community overall service levels will be maintained at up to a hundred and sixty-five thousand sessions and this will assist GPS and psychiatrists support to this important client group my department has now advised peak bodies and key stakeholders of this and the Department of Human Services will shortly be notifying participant organizations of the 2015 16 arrangements having seen a lot of mental health nurses working in primary packed practice I was very determined that we continue with this successful program and I noticed you’ve got some discussions on your program about so much anxiety depression and other mental health conditions presenting in the ordinary course of the things that you do and the nurse model mental health nurse model in general practice in my view works incredibly well because the patient is there for the other reasons that they’re there and somebody will say look just pop in and see the mental health nurse or perhaps see the person by name rather than giving them that title and they can therefore operate in so many different ways across the patient community and the patient families now the latest update report on Australia’s future health workforce predicts significant shortages of nurses over the next 20 years although I understand that the number of graduate nurses in there very early stage of their career is at high numbers when I talked about this with the College of Nursing we discuss the possibility of the government in the government support in the way of scholarships being directed at those first-year graduate nurses so I quite like that idea of talk to rosemary about it and we might work up some some further models because it’s important that nurses in that very early stage when they do need intensive support and mentoring so they don’t end up being frightened away from the hospital system or indeed the primary care system and they have confidence to undertake the next stages of their career so I look forward to a penis input on on that it’s important to attract more people women and men into nursing and to retain them but while doing this we have to maintain the quality of training and the affordability of care so I very strongly support the involvement of nurses in primary healthcare and I believe your role will naturally increase as Medicare and the primary health system are reformed and modernized so please be reassured I will continue to consult with you every step of the way and your organization’s will be represented on the various bodies that actually change policy and make a difference for the future I met with a group of nurses recently who said you know you sit down and talk to doctors but if you sit down and talk to a group of us you will find out exactly what’s going on system so some of what sometimes what I do is somebody contacts me out of the blue and I sit down and have a cup of coffee with them and I find out exactly what’s going on so I’m open to those invitations because they do they do inform in a in a really positive way the things that we do can I just say lastly again thank you for being here I was invited to buy another allied health group who came to see me yesterday and they said we’d love you to come to our group where we were in Canberra in August and I said I can’t believe I could be in Canberra in August thriller to be on the Gold Coast view is fantastic I’m just doing a flying visit I’m going from here to Brisbane so excuse me for leaving straight away and then I’ll get home tonight at about nine o’clock so I’m very excited about that after budget week my electorate so none of us as members of parliament can possibly not give our the areas that we represent a big plug is western New South Wales including the Murray and darling rivers and it’s about a third of the state and because everybody in Australia lives on the coast we are getting larger in the areas that we represent and if I can you know your practice is those of you who work in regional rural and remote Australia probably experienced the same thing having to travel longer distances having to do more over greater geographic areas so at the next election I will be standing on the Ritz quite likely standing on the ridge line of Matt kosciusko and looking to the Queensland border and quite a lot of the country in between so I’m very grateful that in an early career is a pilot i’m able sometimes to fly myself around so just a last plug for rural regional and remote communities and the work that you do in

them and the really really important role that an integrated allied health approach has for all of our australians who don’t necessarily have the advantages of living in the city so thank you again for having me thank you Karen for the amazing work you and your team do and enjoy the conference lovely Thank You Minister thank you Karen Karen did you want to say anything further or yes okay take it away really wanted to extend again our thanks to the Minister for giving us this time and sharing this time with our organization on the Gold Coast given that we know the amount of commitments that you have so thank you again to the minister Susan laughing thanks Karen thank you Karen Thank You Minister now administer you sure you don’t want to stick around for coffee that’s 400 people here that would love you to have a coffee with them and sure you could just clear your schedule for the rest of the day stick around with us we’ve got a boldly would night tonight what’s your Indian dancing like what do you like a petting the dog and screwing the local you can do it says and I can imagine you can do it um thank you both very much our next guest has had a long and illustrious career in nursing she’s also consulted to the world health organization was recognized as a fellow of the Australian College of Nursing made an emeritus director of nursing at Royal Adelaide hospital and was awarded the degree of doctor of the university by both my old unit cutie and Flinders University today in addition to holding the order of australia the title of australia’s first commonwealth chief nurse and midwifery officer and excuse me something happened and the 26th president of the international council of nurses she advises the Minister for health and the Department of Health and Ageing on a range of Nursing and Midwifery issues she’s quite the underachiever would you please welcome dr. Rosemarie Bryant ayo thank you very much it’s lovely to be here with you all again and perhaps I could just start though with acknowledging the traditional owners of the land upon which we are meeting today the Bunge people and pay my respects to the elders past and present and I would also like to extend this respect acknowledgement and welcome to other Aboriginal and Torres Strait Islander people who may be attending today’s event so i would like to thank karen booth and alexis hunt for inviting me here today but i’d also like to acknowledge you Minister of the Honorable Susan Lee MP Minister for health and Minister for sport it is a real pleasure though to be with you again today some of you will recall possibly only a few of you that I started that that my association with nurses working general practice started in 2001 when we had a budget initial I wasn’t working in the Commonwealth then with there was a budget initiative to unusual to initiate the set up the first nursing in general practice program so when I was when Karen was speaking earlier I was reflecting how far far you had come since that time and these Liz medley nodding ahead and and lynn who has a couple of the original shall we say so it’s really nice though again to be here given that this is my final aetna conference because I will be relinquishing my position very shortly I was invited to speak on leadership and advocacy which in many respects can be transmuted into this year’s conference theme of brave to bold one must be brave of course to be a leader and be bold to harness perkasie and by advocacy which is no the word advocacy and the actions associated with it are no stranger to us in this room because I think from day one we are taught about patient advocacy in particular but i’m referring to various types of advocacy for example for our patients the profession and ultimately for change so i have been running around the country a bit with particular just having been international nurses day and having given a number of presentations

so i sort of reflecting on my past and I have been reminded of my own audaciousness in line with this theme which I think was considered rather bold when I began my nursing education in 1963 and it was in Queensland at the Princess Alexandra Hospital it was compulsory of course to live in the nurses home and the attendant rules associated with living in I felt very Petty and constraining as a result I as a people said to me no do you remember your first matron and so and so forth I knew her very well because I was frequently in her office always in trouble always doing something that wasn’t quite right but the misadventures were there but it also when I think back it was also about a lot of mine carry on was about patient advocacy so you know I started young shall we say bravery and boldness though our court raised for future leadership and advocacy within our profession and which ultimately culminating changes within the broader health care system and both Karen and the minister have outlined some of the many changes that have taken place over the last year’s and the changes that are in the system to come change of course is absolutely necessary and some of you may know this quote but I will repeat it as florence Nightingale’s unless we are making progress in our nursing every year every month every week take my word for it we are going back one of our greatest challenges and again Karen alluded to this is achieving change in achieving changes learning how to be leaders at the policy level too often we’re not present at the levels where policies is formed to influence policy at national and international levels nurses and midwives need to develop leadership and advocacy skills bravery and boldness in today’s terms these skills include lobbying critical and strategic thinking and effective communication as well as knowing how to negotiate and form strategic partners and alliances if we’re not at the policy table we will face barriers to access for resources to do our work and improve access to health care for our patients and I am reminded by this comment reminded by the work done in the United States by the American Nurses Association who partnered with are going to remember the name but partnered with a patient advocacy organization and together they were a real force in achieving the passage of the Affordable Care Act in the United States so that that to me is a really good example of how strategic partnerships can be for the for the good but as nurses and midwives are in it we are in a unique position to understand the health context from the service delivery setting to public policy formulation and implementation there is a great need to fulfill the growing stakeholder demand for nursing midwifery input and leadership so as part of this we must nurture future leaders and foster confidence amongst those able but inexperienced in the planning and policy arena strengthening leadership in nursing and midwifery is vitally important so that we can meet our professional obligations to identify and lead positive change throughout the entire health care system I think that this will require an honest and inward examination of how to support leadership development within Nursing and Midwifery a couple of weeks ago I spoke at I was invited to speak at the Jordanian nursing councils 5th international conference and I began my presentation with a quote from Carleen kerfoot a well-known nursing academic in her article the leader as synergist koufaxes and i quote a leader cannot provide direct care a leader must work through others to accomplish the work but the leader is only as good as the people who are providing that care the leaders obligation is to create the environment in which good people can provide good care and I in the quote the crux of that quote for the purposes of today’s presentation lies within the last line the leaders obligation is to create the environment in which good people provide

good care some years ago when I was a director of nursing and was mentioned actually in my introduction at the as it happened at the Royal Adelaide Hospital I was often asked why I had in inverted commas abandoned clinical practice for nursing administration when my response was always that being very familiar with the frustrations and obstacles encountered by nurses and midwives at the bedside my main purposes are nurse administrator was to support those who were delivering the care because I understood the environment so well and a director of nursing is in a very powerful position to do that I suppose that’s my roundabout way of saying that leaders are not only capable of influencing an environment conducive to high quality care but they also have the capacity to shape the policy to create the very environment and health system in the first place just for a moment let’s consider the changes within the profession that we’ve witnessed because of the brave and bold leaders who have come before us in Australia for exam we have seen nursing education transferred to the tertiary second setting and of course we were the first country in the world to do that we have also seen nurse practitioners and midwives who work at an advanced level being able to provide services under the MBS and prescribed under the PBS and we sure will see more changes in that arena soon and particularly relevant to today’s audience the practice nurse incentive program the current one provides incentive payments to practices to support an expanded role for nurses working in general practice and of course in July as well until first of July 2010 the National Registration credit ation scheme for health practitioners was established by the state and territory governments and that for though that that was a really really large and and important advance and with the nursing profession in particular started the lobbying for that change in 1988 so from 1988 onwards we were working towards that thought that a national scheme and of course we were told constantly Constitution doesn’t allow it’s not going to happen well it did happen so it’s a very good example of you know tenacity and and being brave and bold and getting there and they were not all of these changes have not come about in a vacuum they were an hour directly correlated to the Brave and Bold people who Lobby an advocate advocate and lead but I would also encourage you in concluding to be bold and brave and be plucky and courageous and be a nuisance as I was absolute nuisance so they’re very pleased when I departed from the princess alexandra hospital mind you I was invited back there I was there only on Tuesday this week and they gave me a framed copy of my training record and kai and I have to be very frank with you I have been busy I got back from Brisbane pinoy on Tuesday night for budget night I was in the office Wednesday came up here so I’ve been very busy I haven’t unwrapped it yet I’m going to I’m not I’m not I’m not gay enough actually well I will be when I have a cup of coffee and I’m relaxed trap so look at it I know it’ll be awful but you know you know I haven’t done too badly given that it shall we say but it’s also just and finally it’s only when voices are heard loudly and clearly and in a chorus they’re very important i could go on about that but i won’t in a chorus very important working together that we are able to bring about about change within the profession so I wish you well for a conference looks program looks great and once again thank you all very much for inviting me thank lovely thank you so much rose mean I believe Julianne you’ve got a little gift yes um just very briefly rosemary I certainly related to some of rosemary stories we go back a long way and I spent a considerable amount of time in Rosemary’s office also and I might just say at the end of my training she didn’t invite me back my first year as a graduate nurse was spelled spent

elsewhere but here we are today well pretty well yeah you did all right to ya so Rose read da molto confirm appt that we know that I dinner will be in your heart and Liz medley will tell you we don’t let go of people let’s say they’re retiring so we’ll keep you in our fold thank you so much what you’ve done to nursing you have touched every nurses heart in Australia and there should be no I truly believe that thank you you’re our first chief ness and geary officer we love you and have a great retirement o beautiful chilly and beautiful beautifully said you