May 12, 2021

General

New research backs ratios on International Nurses’ Day

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Calls for shift-by-shift ratios to be introduced in New South Wales have been bolstered, as thousands of dedicated nurses begin and end their shifts around the clock on International Nurses’ Day.

New research released in The Lancet today indicates better patient outcomes are achieved in hospitals with improved nurse staffing, a position backed by the NSW Nurses and Midwives’ Association (NSWNMA).

NSWNMA General Secretary, Brett Holmes, implored the NSW government to act on the findings which evaluate Queensland’s ratio legislation on nurse staffing and patient mortality, readmissions, and length of stay.

“This research is further proof of why we desperately need shift-by-shift ratios in NSW,” said Mr Holmes.

“We know that safe staffing, through minimum nurse-to-patient ratios not only improves patient outcomes but also saves money.

“Enough is enough. The NSW government must stop relying on nurses’ goodwill to stay at the bedside. They deserve to be valued with shift-by-shift ratios and fair pay.”

In a message to nurses, Prince of Wales Hospital Mental Health Branch Secretary, Skye Romer, said after being on the frontline during the pandemic, the urgent need for ratios was crystal clear.

“Our workloads are not sustainable. We’re tired. We’re burning out and we feel unsupported at work,” said Ms Romer.

“We’ve been seeking ratios in NSW public hospitals for over a decade and in residential aged care for even longer, but stubborn governments refuse to listen. Now, we don’t even feel like celebrating our own professional day.”

NSWNMA Assistant General Secretary, Judith Kiejda, reiterated the importance of ratios on International Nurses’ Day.

“Our members want to offer the best possible patient care with safe staffing. The NSW government has the power to do this.

“We call on the NSW government to value nurses and midwives by delivering shift-by-shift ratios, improved conditions and fair pay, not a pitiful 1.04% offer.”

Aged care nurses frustrated and disappointed

Frustrations have also reverberated across the aged care nursing workforce, following last night’s disappointing federal budget.

Despite promising a ‘once in generation’ reform package, the Morrison government failed to commit to mandated minimum staffing levels in the aged care sector.

NSWNMA Councillor and aged care nurse, Jocelyn Hofman, said she was furious.

“A $17.7 billion cash splash sounds impressive, but the devil is in detail and this budget falls well short of what residents, communities and aged care workers need to fix the sector,” said Ms Hofman.

“Mandated minimum staffing and skills mix are desperately needed now to provide the appropriate care to residents, with a registered nurse on-site 24/7, just as the royal commission recommended, not 16 hours with no requirement to be on site”

“We all know staffing is at the heart of best practice care, so why is it still too much to ask?”

The NSWNMA will continue campaigning for all recommendations of the Aged Care Royal Commission to be adopted in full.

Ratios are key to reducing violence

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Achieving the NSWNMA claim for ratios would help to reduce the level of violence and aggression in mental health units, says Eliza Wright, secretary of the NSWNMA’s Blacktown City Mental Health Branch.

She says ratios would “give us the capacity to spend meaningful time with our patients and get to know them better, so we can anticipate problems more easily and de-escalate incidents a lot more effectively”.

She says the NHPPD (nursing hours per patient day) system doesn’t adequately take into account the acuity of patients and gives management too many loopholes.

These loopholes regularly leave Eliza’s ward with around one nurse to six patients on morning and afternoon shifts and one to eight at night, which, she says, is seriously inadequate.

The NSWNMA recently went to the NSW  Industrial Relations Commission to successfully block a management attempt to cut morning shift staffing at the acute mental health unit of Blacktown Hospital.

Management claimed the shift was overstaffed according to the NHPPD formula.

“We successfully argued that NHPPD was supposed to be the bare minimum level of staffing and a staff cut would be detrimental to both patients and staff,” Eliza said.

“If we had proper ratios the staffing requirements would be clear and that would benefit mental health units across the whole state.

“Nights are particularly volatile, we’ve got a skeleton staff, but we still accept admissions, so anything can happen.

“Only a week ago,  a patient assaulted all four nurses on night shift. One of them was punched repeatedly while another was physically held hostage. It was a horrific incident, and those nurses all required time off work. They feel shaken up and overwhelmed.

“Incidents like these leave us feeling unsafe and undervalued at work, especially when it feels like management is more interested in cutting staff to save money. We shouldn’t have to go to work not knowing if we’re going to make it home safe that night.

“Having four nurses on night shift does not even allow us to effectively observe the de-escalation guidelines which say you need five nurses to restrain a violent patient.”

Eliza says free parking for nurses is another important aspect of the award claim.

“Most nurses have no alternative other than to drive to work but parking is difficult. Some people have to park in the two-hour zone and keep running outside to move their car.

“I have the cost of onsite parking deducted from my pay and it’s over $1000 a year.”

Award claim aims to protect ICU standards

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The NSWNMA’s claim for ICU staffing ratios draws on feedback from a statewide ICU nurses’ forum.

Forum member Michelle Rosentreter, who is president of the NSWNMA’s Hornsby Hospital branch,  says ICUs are not covered by a NHPPD (nursing hours per patient day) formula.

Instead, Hornsby ICU nurses aim to follow guidelines formulated by the College of Intensive Care Medicine of Australia and New Zealand and the Australian College of Critical Care Nurses.

The guidelines apply to work practice, caseload, staffing and operational requirements for the ICU.

“The guidelines are the minimum standards needed to keep our patients and staff safe,” Michelle says.

“Minimum standards are paramount in ICU because of the level of technology we use, the drugs we use and the amount of education we need.

“On average, it takes a nurse about five years to reach a level of competence and confidence needed to deal with the critically unwell in ICU.”

Michelle says that in the absence of ratios, ICUs are under pressure from hospital executives to take more patients than is safe.

“People running hospitals may lack knowledge of what is required to manage patients with life threatening illnesses. It can’t be compared to ward staffing.

“You might hear an executive member say, ‘ICU has got six nurses and only three patients.’

“But those three patients might be hooked up to over 15 infusions, have an artificial airway and dialysis as well as requiring CPR, while you have the primary nurse and another nurse helping to maintain their airway and keeping them haemodynamically stable”.

“I’ve been appalled to learn that some of our tertiary hospitals do not follow the minimum staffing standards developed by these colleges – most notably no free Team Leader/Clinical Coordinator or ACCESS nurse.

“My heart sank when I saw the struggles my colleagues are having at some hospitals, where they are not heard by their executive or 
their district.

“For instance, at one level 6 ICU – the highest level – the clinical coordinator running the unit also has to do direct patient care and support junior nurses, while trying to manage deteriorating patients and respond to emergency code blues.

She says it’s time the Berejiklian government and the Ministry of Health listened to nurses and midwives.

“We need a fair and reasonable pay increase, shift by shift ratios and better conditions for work – to deliver the care we are trained to do and not to be disregarded.”

New wage cuts rotten to the core

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One month after being dealt a bitter 0.3% wage freeze for 2020, thousands of nurses and midwives who have kept public hospitals and health services running across NSW will now face further wage constraints.

NSW Treasurer Dominic Perrottet has announced the Berejiklian Government will cap annual public sector wages growth at 1.5% in the upcoming NSW Budget, to reportedly save an extra $1.8 billion over three years.

The NSW Nurses and Midwives’ Association (NSWNMA) represents more than 45,000 public sector nurses and midwives who were already reeling from the 0.3% wage freeze, delivered as they continue to tackle COVID-19.

NSWNMA General Secretary, Brett Holmes, said the Treasurer’s decision to cap wages growth at 1.5% and hint actual pay rises could be even less from next year was opportunistic and economically reckless.

“At a time when the Berejiklian Government should be investing in wages and securing the future of our health workforce, they are locking NSW into a low wage, low growth future that will send nurses and midwives interstate,” said Mr Holmes.

“Why wouldn’t a nurse want to flee to Queensland or Victoria where they can work with better pay and legislated nurse-to-patient ratios?

“For the past nine years, public sector workers have received a 2.5% wage increase to spend in their local shops and support local businesses. Now the Berejiklian Government is using the pandemic as an excuse to penalise the very people who have worked through COVID-19 and kept NSW safe.

“Queensland, Victoria and South Australia have all managed to recognise the contribution of their public sector workforces with modest increases, yet the Berejiklian Government refuses to acknowledge their worth in NSW.

“Public sector wages influence private sector wages and when employers in the private sector see no real wage growth occurring around them, they also put the brakes on. The Treasurer is blatantly ignoring this and will force our economy further in a downward spiral – the opposite of what we need to recover.

“It’s a low blow from the Treasurer and Premier who are bullishly determined to prioritise hard-hats and high-vis opportunities over securing the future of our health workforce in NSW.”

Queensland ratios win improve outcomes for nurses and patients 

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Researchers have found sizeable improvements in patient safety and staff satisfaction arising from the Queensland Nurses and Midwives’ Union’s nurse-to-patient ratios win in 2017. 

The research, published in the British Medical Journal, showed measurable qualitative improvements in both patient and staff outcomes. 

For example, researchers found a 12% drop in 30-day mortality rates per reduced patient per nurse where nurse-to-patient ratios were implemented. 

The research also found a 15% drop in emotional exhaustion and 14% drop in job dissatisfaction for each reduced patient per nurse. 

The implementation of nurse-to-patient ratios also resulted in more consistent staffing levels in the wards where the mandated ratios were present.  

The union has continued to campaign for the roll-out of nurse-to-patient ratios in more wards and clinical settings in the lead up to the Queensland State Election on 31 October 2020.  

The NSW Nurses and Midwives’ Association is also campaigning for nurse-to-patient ratios. Support their campaign by signing this NSW Parliament e-petition.   

Health workers catching COVID on the job

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A Victorian government report has found that 70–80 per cent of the state’s health workers testing positive to COVID-19 were infected at work. That’s compared to 22 per cent in the first wave.

The report found infection of healthcare workers was greatest in areas where there were many patients with COVID-19 being cared for together, and where health-care workers congregated, such as tea rooms.

Other contributing factors were the increased risk associated with donning and doffing personal protective equipment (PPE), staff moving between healthcare facilities, and poor ventilation systems with inadequate air flow.

The report found health-care workers in aged care accounted for around two in five infections, and hospital workers around one-third.

By the end of August the number of health workers infected with COVID-19 in Victoria had exceeded 2800.

“Controlling the number of new healthcare worker infections is essential, not only for healthcare workers but for the sustainability of our healthcare system, and to reduce the overall number of cases,” commented Alicia Dennis, an Associate Professor at the University of Melbourne in The Conversation.

The Victorian government has convened a Healthcare Worker Infection Prevention and Wellbeing Taskforce bringing together infection control experts and workforce representatives to formulate a response to the report.