ICU nurses struggle to maintain standards
Politicians say hospital staff are “coping” during the pandemic, but ICU nurses tell a different story.
Hundreds of intensive care nurses across NSW have signed an open letter to Gladys Berejiklian, pleading for more staff.
“Given the chronic unsafe staffing conditions, exacerbated by COVID-19, we cannot deliver the care you expect us to provide and the level of critical care our patients rightly deserve,” the letter said.
More than 700 ICU nurses had signed the letter by early September.
It said ICUs were in crisis even before the pandemic.
“We experienced chronic understaffing, an increased junior skills mix as a result of senior staff leaving due to burnout, and ever-increasing workloads.
“The added demands of [COVID-19]… are forcing our clinical workforce to the brink, placing our registration at risk on every shift and compromising safe patient care.”
NSWNMA General Secretary Brett Holmes said members wanted assurances from Premier Berejiklian and Health Minister Brad Hazzard that a one-to-one nurse-to-patient ratio would be mandated for ICUs after the current health emergency. “Members have told the Association of the need for ACCCN staffing standards to be introduced as a minimum for all ICUs,” he said.
Following media coverage of the letter, Hazzard met with a representative group of ICU nurses led by the NSWNMA and agreed to further meetings.
Hazzard had earlier assured a media conference: “All the information given to me from the doctors and nurses and our public health staff is that the system is coping.”
Premier Berejiklian predicted October would be the worst month for people needing intensive care, and added: “Once we start re-opening, cases will go through the roof, but it won’t matter so much as we will be vaccinated.”
Short-staffed before COVID-19
NSWNMA member Louise Nakkan is a 30-year veteran of Westmead Hospital Cardiothoracic ICU, where she is a clinical nurse educator (CNE).
Louise says there is “a huge disparity between what we are seeing on the front line and what the government and top management are saying.”
“I’ve never seen it this tough before. We’re hanging in there, but some days are dire.”
Westmead’s ICU has a 36-bed General ICU section divided into three “red” pods for COVID-19 patients. A separate, 10-bed cardio-thoracic pod cares for “green” non-COVID-19 patients and “amber” patients who are in isolation and awaiting COVID-19 test results.
Louise said ICU had serious staffing and management issues even before COVID-19.
“NSW Health didn’t do enough to recruit and to keep the staff they already had.
“Going into a pandemic desperately short-staffed, they decided everyone had to rotate through shifts. This took people away from shift patterns they’d worked for many years, and it led a lot of them to resign.
“Some retired and others went to vaccination hubs, where if you’re working for a private enterprise it’s good money and a lot less stress.
“In my pod, cardiothoracic, we have lost nine mostly part-time staff over the last three months. That’s a huge resource of knowledge lost to the system.
“Management just doesn’t listen to what people want – things like safe staffing, fair rostering, ability to take annual leave and fair pay.”
Some shifts are chaos
Louise said that on any given shift, General ICU could be short eight or more nurses, based on already inadequate staffing ratios.
“You can’t just pull eight nurses out of thin air, so it’s just a matter of surviving from one shift to the next.”
Additional staff were upskilled to become critical care nurses last year, but Louise says they are no longer available.
“We’ve had to start again, with staff from theatres, recovery and the casual pool frantically being upskilled.”
Louise works mainly in the cardiothoracic pod, with nurses who have worked alongside each other for up to 20 years.
“It’s a real team approach and we always try to have each other’s backs, but some shifts are chaos.
“Yesterday, the nurse unit manager, clinical consultant and the other CNE were all on the floor because we were down staff.
“We try to look out for each other, but everyone is exhausted and fearful about what comes next in the pandemic.
“Nurses working in the red pods are in full PPE – P2/N95 respirator, goggles, hair net and fluid-impervious gown – nearly all the time and it’s exhausting. They come out drenched in sweat.”
Nurses are also under the strain of trying to comfort very sick people who cannot have visitors.
“We’ve had a lot of deaths and you feel very sad, but you don’t have time to debrief. You clean the room and send the patient to the morgue and you’re setting up again for the next patient.”
Louise adds that Westmead’s emergency department “is in its own world of pain. Some days there are a dozen ambulances parked outside waiting to offload patients.”
The pandemic has thrown up issues such as PPE, fit testing and staffing for safe workloads, which has led to more ICU nurses getting involved with the NSWNMA at the local level.
“People have become much more aware they need to be informed and have their say,” Louise says.
“We’ve had big turnouts of staff logging on to see what’s happening and what issues the union is taking forward for us.
“People realise the union is there to help us keep ourselves safe and our patients safe.”
Meanwhile, the NSWNMA has filed a dispute in the Industrial Relations Commission over unsafe staffing of Westmead’s COVID-19 wards, where nurse-to-patient ratios are well below those comparable with other major hospitals.