When Shaye Candish heard NSW Premier Dominic Perrottet on the news talking about union bosses recently, it took her a minute to realise he was talking about people just like her.
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Earlier this month, the former emergency department nurse was appointed General Secretary of the NSW Nurses and Midwives Association (NSWNMA) - the state arm of the biggest union in Australia.
A 36-year-old Woonona resident and mum to two young boys, she says she's not what people picture when they hear the words union boss.
"Dominic Perrottet got up in the last budget announcement and there was a question from a journalist about nursing ratios and he said 'I understand the union bosses aren't going to like this' and I thought it was hilarious to think he was talking about me," Ms Candish said.
"The public and politicians have a perception, a convenient perception, that a union boss means this big, angry man.
"But the Australian Nursing and Midwifery Federation nationally is the biggest union in the country. So if you talk about the average unionist, it's a nurse, or a teacher, which is the other big union.
"So actually, a unionist does look like me - female, professional, middle aged."
Ms Candish took over as NSWNMA General Secretary from long standing union boss Brett Holmes, who retired earlier this month, and now represents 74,500 members.
The union has vowed to continue its fight for better pay and nurse-to-patient ratios all the way to the 2023 state election.
Its members are exhausted, burnt out and angry. They are working in a health system showing big cracks, with hospitals recording long emergency department and ambulance waiting times and struggling to get on top of the huge backlog for elective surgery.
There's a shortage of aged care beds leaving older patients stuck in hospital, and people can't get in to see GPs which means they end up in hospital instead.
"Look, I'm completely terrified to be honest, but I'm an eternal optimist and I think there's a whole bunch of opportunities facing us right now to reimagine what healthcare can look like," Ms Candish said.
"It doesn't matter who is in government, whoever it is is going to end up with a deteriorating health system.
"We need people who are going to reimagine new solutions, and nurses and midwives are going to be critical to that, because we are the biggest component of the workforce.
"Coming into three years of a pandemic, we've seen people doing routine overtime, double shifts, filling vacancies with extra days on, and coming to work not being able to deliver the care they want because of understaffing.
"It's generating a normalisation of overwork, and the result of that is that we're seeing nurses and midwives leave the industry."
Shaped by her early experiences as a nurse
Ms Candish started her career working in Campbelltown Hospital emergency department and never aspired to work at a union.
But her early experiences working in a system that made her feel like a failure as a nurse, and banding together with her colleagues to change things, opened her eyes to what the union could do.
"I became active because we only had one nurse in the [resuscitation] beds on a night shift, there were four beds and that's where your absolutely most critically unwell patients go," she said.
"These are people coming in on a breathing machine, you might be giving a small child Ventolin because they can't breathe, you've got people having a massive stroke or a huge heart attack. You can't do that with one person.
"I was [leaving work] having this devastation, thinking 'oh my god, I can't believe that patient didn't die'. It was too traumatic to do that every day. So, I pulled together a group of likeminded people and we campaigned, and we ended up getting an extra nurse."
After that, she was encouraged to apply for a role within the union, starting out as a organiser, and has since worked her way through a number of major campaigns and roles to become the General Secretary.
"Once I realised that the failure was actually with the system, I knew I didn't want a career where I would just turn up every day and feel dissatisfied with what I was able to do - I think that's a tremendous burden for people to have to carry," she said.
After working through the pandemic, Ms Candish says many nurses feel a similar burden and she is determined to help them get systemic change.
"We're talking about this thing called moral injury, which is referred to when you're talking about people in war zones, when you're turning up and having to make decisions that go against your values," she said. "At the peak of it, we're seeing people with post traumatic stress. People are making decisions to protect their own health, they are leaving, retiring early, or dropping hours - whatever it is they can manage to protect their own welfare."
The solution the nurses and midwives union wants is nurse-to-patient ratios, which would mean each nurse would look after a guaranteed number of patients on every shift.
"Ratios would be a circuit breaker," Ms Candish said. "Nurses might not be able to fix everything, but they know that the four patients that they have today are going to get the care that they deserve.
"At the moment, it's quite common that a nurse will turn up and have seven, eight or sometimes 15 patients."
NSW Health currently uses a staffing system which looks at "nursing hours per patient day", which the health department says is more flexible because staffing levels can be adjusted to reflect changing needs.
The union has been calling for ratios - which are already in place in other states - for about 10 years, and Ms Candish says there is a large body of evidence showing the system works and saves money in the long term by giving patients a better standard of care and keeping them out of hospital.
However, it's unclear if there is political will from either side to support ratios, with Labor raising concerns earlier this year about what it would cost to change the staffing system.
"We deserve a seat at table and we're demanding it now."
Meanwhile, the union is turning up the pressure. This week, 94 per cent of the NSWNMA's public nursing workforce voted to strike for 24 hours on September 1.
It will be nurses' fourth round of industrial action this year, and - as well as being spurred on by frustration and anger at working conditions - Ms Candish sees it as part of a wider movement towards recognising work traditionally done by women.
"We've seen at the federal election that lots of fantastic professional women who put themselves forward as legitimate for their communities got elected," she said.
"Women are demanding a space in the public discourse and that's really exciting, and I think for teachers and nurses here in NSW, they're on this wave as well.
"It feels incredibly frustrating for our members that a man in a suit somewhere gets to decide whether or not someone's child can access the quality health care that they need.
"We deserve a seat at table and we're demanding it now."
As Ms Candish starts her tenure as the leader of tens of thousands of nurses who say they won't give up until they're heard, her fight for a better health system is personal as well as political.
"I'm a nurse, just like all these other nurses that are out there, saying this is not enough," she said.
She's also a community member and mother, she says, who worries about long emergency department waits and a lack of hospital beds affecting her family.
"I want to know that when my kids have something, I can take them to a well-resourced hospital and I would hope that every other person in our area has the same expectation," she said.
"In March, we had a really big meeting at Sydney Town Hall, and our members took industrial action and off they marched into Town Hall. I was sitting on the stage and got a call from daycare, and my son had broken his nose. So I had to go and pick him up and sit in Urgent Care in Bulli, watching this meeting on the news while the nurse there gave fabulous care to my son.
"I thought it was the absolute epitome of what's happening here. We were trying to do this big political piece, but I had to go and get called away to ED."
Kate McIlwain
For more than a decade, I've helped the Illawarra Mercury set the news agenda across the region. Currently I'm the paper's health reporter - covering the stories of Illawarra workers and residents in the wake of a global pandemic and at a time where our health systems are stretched to the limit.
For more than a decade, I've helped the Illawarra Mercury set the news agenda across the region. Currently I'm the paper's health reporter - covering the stories of Illawarra workers and residents in the wake of a global pandemic and at a time where our health systems are stretched to the limit.
