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July 2, 2022
  • THE MAGAZINE OF THE NSW NURSES AND MIDWIVES’ ASSOCIATION
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Emergency

Government risking lives the longer it delays staffing ratios

June 15, 2022 by Rayan Calimlim Leave a Comment

Further evidence of the unsustainable strain on public hospital emergency departments (ED) has prompted angry calls for the NSW government to stop risking patients’ lives and introduce reliable shift by shift staffing ratios.

The NSW Nurses and Midwives’ Association (NSWNMA) issued the warning after Bureau of Health Information (BHI) data for January to March 2022 showed patients waited longer for ambulance transfers, for treatment in ED, and to be admitted to a ward, despite less attendances overall than the same quarter in 2019.

NSWNMA Acting General Secretary, Shaye Candish, said as the Omicron variant ran rampant in the community, patients requiring triage category 2 ‘emergency’ care waited longer for ED treatment compared to any January to March quarter on record.

“The latest hospital data reinforces what we were hearing from members at the time about the incredible pressure they were working under, not long after the NSW government took their ‘let it rip’ approach in mid-December,” said Ms Candish.

“Members tell us that pressure and the strain on the health system continues today, with the winter peak well and truly upon us.

“According to the BHI results, barely a quarter (25.8%) of patients who were treated and admitted to hospital spent less than the benchmark of four hours in the ED. Alarmingly, one in 10 of them spent over 18 hours and 29 minutes in ED.

“How can the NSW government continue to call this ‘world class’ care? Our state desperately needs a transparent nurse-to-patient ratios system to improve staffing, reduce workloads and help manage the ongoing demand.”

NSWNMA Acting Assistant General Secretary, Michael Whaites, said calls for one nurse to every three ED treatment spaces (1:3 in ED) would go a long way to curb the rising number of patients who are leaving without even being seen.

“A record 55,305 patients left EDs during January to March either without being seen, or before finishing treatment, that’s the worst it’s ever been and it must be addressed,” said Mr Whaites.

“One in 10 who arrived by ambulance also waited almost an hour (54 minutes) to be transferred to ED staff. This is the opposite of the level of safe care patients in NSW deserve.

“The volume of COVID-19 patients requiring hospitalisation during the January peak put enormous strain on the entire public health system. Meanwhile, almost 20,000 (18,627) elective surgery patients had waited longer than clinically recommended by the end of the quarter.

“The NSW government can start to fix this now by introducing shift by shift staffing ratios, because clearly its preferred staffing method is no longer fit for purpose and our health system will continue to suffer until change occurs.”

Poor ED staffing continues to impact patient care

May 4, 2022 by Rayan Calimlim 1 Comment

Ongoing pressure inside public hospital emergency departments (EDs) has prompted renewed calls by the NSW Nurses and Midwives’ Association (NSWNMA) for staffing ratios to be mandated on every shift.

The NSWNMA wants the NSW government to introduce a ratio of one nurse to every three ED treatment spaces to improve patient care, backed by Bureau of Health Information (BHI) figures that show patients’ rating of overall care in December 2020 to June 2021 fell below 2019-20 levels.

According to the BHI, overall ED patient experiences were significantly lower than the state average at Blacktown Hospital, Inverell Hospital and Nepean Hospital.

NSWNMA General Secretary, Brett Holmes, said the data showed ED staff were unable to check on as many patients while they waited for treatment in John Hunter, Wollongong, Belmont, Westmead, Nepean, Shellharbour and Wyong hospitals, which all performed worse than the NSW median.

“We’ve indicated to the government numerous times how tough conditions have become inside many emergency departments due to chronic understaffing issues,” said Mr Holmes.

“Short staffing was impacting on patient care and safety well before the pandemic and these results show how it was exacerbated during COVID-19 peaks.”

The BHI data indicated one in five ED patients (19%) statewide said they received contradictory information about their condition or treatment.

At Inverell Hospital in the New England, only 42 per cent of patients thought ED staff worked ‘very good’ together, while 54 per cent said they had enough time to discuss their health issue with staff.

“There’s been no reprieve for our public sector nurses and midwives across the state, and we’re continuing to see them reduce their hours or leave nursing and midwifery entirely,” said Mr Holmes.

“The volume of overtime they’re being asked to do, growing skills mix issues and recruitment delays are continuing to take a toll. We need nurse-to-patient ratios of 1:3 on every shift in our emergency departments and the NSW government needs stop relying on its decade-old staffing model that no longer reflects the volume of work necessary to meet demand.

“It’s not good enough. NSW patients deserve better health care and staff deserve safe working conditions.”

“Disappointed”: College of Emergency Medicine pans Liberal health ‘recap’ 

April 28, 2022 by Rayan Calimlim Leave a Comment

The Australian College of Emergency Medicine (ACEM) has criticised the Liberal-National Government’s pre-election announcement on health, describing it as merely a ‘recap’ of past announcements without any genuine solutions for the future of Australia’s healthcare system.  

ACEM condemned the incumbent government for its lack of investment in the health system, particularly around the Primary Health Care 10 Year Plan that was released by the government earlier in the year.  

“The Liberal’s health plan is hollow and lacks any genuine content. Australians need our political leaders to show leadership, vision and the capacity to translate the vision into action,” said ACEM President Dr Clare Skinner.  

“The solutions to the problems plaguing health across Australia are not easy, and they are not quick. But genuine leadership isn’t supposed to be easy. 

“We need leaders who will stand up for health and can bring all parts of the healthcare system together to reimagine a better, more equitable way of doing things”. 

ACEM indicated that further investment in primary and acute health was required to stem the current issues in the sector, including acute access block, ambulance ramping and the ongoing ED overcrowding crisis.  

Hospital emergency departments are under intense pressure. What to know before you go

October 6, 2021 by Rayan Calimlim Leave a Comment

Emergency departments around Australia have experienced COVID in a variety of ways.

From the first quarter of 2020, most if not all have worked hard to plan for an influx of very unwell, highly infectious patients. In the less fortunate of jurisdictions, those apprehensions are being realised — though thankfully not yet to the magnitude seen in some overseas cities.

Hospital emergency departments (EDs) are under intense pressure and there have been calls for the public to carefully weigh up need before presenting there. Don’t come if you don’t need to, they’ve been told. But equally, don’t wait if you need treatment, especially for COVID.

Less staff, more pressure

For all hospitals, COVID planning has involved creating streams of patient flow, to ensure those infected can be treated in addition to and at the same time as those who are not — while preventing the former infecting the latter. This is labour-intensive work, often duplicating patient pathways but without a doubling of staff.

In fact, staff numbers in many EDs are down in Australia, for a variety of reasons. Many smaller rural departments rely on fly-in-fly-out locums, now locked out by lockdowns. At times, doctors and nurses have been furloughed because they have been infected at work or elsewhere, or because they have been close contacts.

Understaffed EDs push on, with the greater burden being carried by fewer health workers, resulting in their subsequent burnout. To that, add the task of working in full personal protective equipment, often for many hours at a time. It is physically demanding, uncomfortable, unpleasant work, in an environment in which both high levels of vigilance to keep staff safe and cognitive skills to manage often complex and rapidly deteriorating patients are required.

Not just COVID patients

Much of the focus in the media on health care in a time of pandemic has understandably been on COVID hospitalisations and subsequent intensive care unit admissions. Less has been said about the impact of COVID on the treatment of other illnesses or injuries.

We are very fortunate in Australia there is still more of “the other” in our EDs than there is COVID. That might change in the run up to Christmas.

The ED is most obviously a place of treatment for acute injuries and illnesses. In addition to that, we treat people with chronic illnesses. The ED can act as a safety net for those who have no one else to turn to and reassure many without affliction. For patients in each of these categories, the experience of ED has changed significantly.

There are great concerns many of those who need immediate medical care are deferring seeking it. They may fear catching COVID or being a burden on a strained system. Many in the latter category are elderly patients and those with probably the most reasonable indications for using our services.

First off, it’s your emergency

So how should we, as a resource-constrained civil society, in the middle of a pandemic, use our EDs?

The first and overriding principle is that any medical emergency is YOUR emergency. If you think you are experiencing a medical emergency — one you cannot see yourself addressing with the resources available to you, at the time you are experiencing it — you should come to ED. It doesn’t matter if it seems trivial to others, it’s your emergency. And we are your emergency department.

If you don’t feel too unwell, and are uncertain where you should go for medical care, there are alternatives to the ED where excellent medical advice and treatment can be found.

Telehealth has been a godsend to both patients and our GP colleagues. There are now also numerous health lines to call. Pharmacists can provide excellent information about medication, as well as now providing COVID vaccinations.

The ED is not the best place to go to have a COVID test. If you are otherwise well, there are many testing locations where you will wait a far shorter time for a test and the results.

Similarly, many concerns about the very rare side effects of COVID vaccination can be addressed with a telehealth consultation and a blood test if required.

Extra precautions, longer waits

If you do come to the ED, try and be patient. There are extra measures in place to keep you safe.

You’ll need to wear a mask and check in with a QR code, use hand sanitiser and physically distance. There are increasingly strict rules about the numbers of visitors.

If that’s a problem, you’re probably going to be asked to leave. It’s nothing personal — we have a duty of responsibility to all our patients.

You might wait longer than expected despite the efforts of medical staff to see everyone as quickly as possible.

EDs treat all comers

Finally, if you’re worried about the consequences of catching COVID, get vaccinated. We treat all comers, with a variety of beliefs about their medical care — all as long as they agree to abide by the rules of “The House”: to be respectful and abide by hospital procedures.

But vaccination will reduce your chance of needing ED attention as a consequence of COVID — and protect you from catching it if you come to ED for another reason.

Working in the ED at the moment isn’t much fun for anyone. We’re all really tired and, for many, that’s even before the ED where we work has become COVID-dominant. We’re looking forward to moving out of this phase of the pandemic, safely. Then we can get back to treating the mishaps of more normal human lifestyles, led to the fullest.

David Caldicott, Senior lecturer, Australian National University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

EDs in desperate need of 1:3 nursing ratios

June 16, 2021 by Rayan Calimlim 3 Comments

Pressure is mounting inside the state’s emergency departments, with the latest hospital data revealing the time patients spend waiting to be admitted has blown-out to more than five and a half hours, the longest median time recorded in the past five years.

The Bureau of Health Information’s latest quarterly report has reinforced concerns raised by the NSW Nurses and Midwives’ Association (NSWNMA) that patients were increasingly presenting in dire need of urgent medical help.

The January to March 2021 figures showed the volume of ‘emergency’ (triage category 2) and ‘urgent’ (triage category 3) presentations were the highest recorded over the five-year period for that quarter.

NSWNMA General Secretary, Brett Holmes, reiterated the NSW government must implement ratios of one nurse to three patients (1:3) in ED and ensure patient safety was prioritised across the system.

“The amount of time critically ill patients are waiting for admission to a ward bed reinforces the absolute need to ensure our EDs have at least one nurse for every three patients at all times,” said Mr Holmes.

“We need shift-by-shift ratios in EDs to ensure patients, who are presenting acutely unwell, can get the right care when they need it.

“These figures confirm it’s taking longer for patients to be seen and leave on time, which is a recipe for heightened aggression and abuse towards frontline nurses just trying to do their jobs.

“Not to mention, the highest number of ambulance responses for any January to March quarter over the past five years, which impacted on the time it took to transfer patients from paramedics to ED staff.

“The volume of elective surgeries carried out, up 13.9% (or 7,065), was also highest for that quarter since 2017.

“Our members know that what happens inside an ED has a ripple effect across their hospital. Safe staffing must be prioritised to help address these concerns.

“Many of our nurses are at breaking point because if they’re not run off their feet in the ED, they’re flat out raising workload issues with hospital management to little or no avail.

We need mandated nurse-to-patient ratios in our hospitals, just like they have in Queensland and Victoria. The NSW government’s preferred staffing model is outdated, unsafe and frequently fails to deliver the right number of nurses needed on every shift.”

The NSW government has refused to negotiate with the NSWNMA on introducing nurse-to-patient ratios, despite widespread industrial actions in metropolitan and regional areas.

Better ratios mean improved outcomes in paediatric emergency

March 22, 2021 by Rayan Calimlim Leave a Comment

Increased nurse staffing has a marked effect upon patient outcomes in paediatric emergency departments, a recent study has shown.

The study, published in the Journal of Clinical Nursing, analysed administrative data of 21,956 patients gathered from a university hospital’s paediatric emergency department in the first half of 2019.

It found that increases of nursing numbers reduced the average stay of patients in the emergency department by 2% per additional nursing staff member.

Further, the study found that a decline in nurse-to-patient ratios correlated with an increase of patients leaving before treatment completion.

It concluded that nurse-to-patient ratios did in fact affect patient outcomes and quality of care in the scenario studied.

While studies on the effects of nurse-to-patient ratios on patient outcomes have been commonplace over the past few decades, the study is the first to focus on a paediatric emergency department.

The study was conducted by a Finish team, led by nursing academic Katja Janhunen.

 

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