What does it mean for a nurse to be made responsible for a hospital with no doctor?

Wee Waa Community Hospital, 576 km north-west of Sydney, is a 15-bed acute care hospital with a 24-hour ED.

Like many small health facilities in NSW, it has no regular Visiting Medical Officer and has lost its on-call GP. Occasionally, a locum is found to cover weekends.

At all other times, Wee Waa relies on nurses. The ratio is three on morning and afternoon shifts, and two on nights.

Often, however, only two nurses can be found to cover mornings and afternoons because the hospital can’t recruit enough staff – a common problem in small towns.

RN and NSWNMA member Susan Marshall has worked at Wee Waa hospital for 27 years. She says that since it lost its on-call GP, the hospital has found it harder to keep senior nurses and attract agency staff.

“When there are only two nurses on the ward, and they attend an ED presentation, they sometimes have to ask the domestic staff to keep an eye on the high-care patients.

“Two nurses are not enough, for example, to resuscitate a patient and cover the ward as well as make calls to a telehealth doctor.”

Some senior nurses have FLECC (first line emergency care course) qualifications, which allow them to initiate higher levels of assessment and treatment.

However, nurses often feel intimidated and vulnerable due to the absence of a doctor, Susan says.

“It seems the government wants staff to be FLECC-trained to plug the gap left by the doctor, but it’s not entirely safe.

“If you must work outside your scope of practice to get the job done, you can feel insecure.

“Not feeling professionally secure in the workplace can lead to unhappiness with the job – and many senior nurses have left.

“I feel I’m doing a job that’s not always recognised – and I don’t always feel supported by the system.”

Teleheath not enough

Susan does not believe that telehealth can always fill the gap created by the absence of a doctor.

“There will always be cases when you need a doctor on site.

“We are supposed to call the ED doctor in Tamworth, but they often don’t have time for a Wee Waa problem, though they are sympathetic to our predicament.

“I have rung them with triage 1 and 2 patients, and they say, ‘I’m running a resus here and I haven’t got time for you.’ Their workload has increased because we no longer have a doctor.”

Susan says having no medical coverage has led to more patient transfers – sometimes to Narrabri (30 minutes away) but mostly to Tamworth, which can be a six-hour round trip.

“This puts pressure on the ambulance service and leaves our community very exposed without ambulance cover.”

COVID-19 would be the last straw

It also puts more pressure on Wee Waa’s nurses, who are sometimes questioned by ambulance control over whether a transfer is necessary.

“The ambulance coordinator will say, ‘Do you really need to transfer this patient? I don’t have an ambulance to do it and my staff are on overtime.’

“To have to debate this with the ambulance coordinator, who isn’t local, is frustrating and eats up time that we don’t have.”

Wee Waa has so far been free of COVID-19 but if it strikes the hospital, “it could be the straw that broke the camel’s back,” Susan says.

“If someone had to get all PPE’d up to look after a possible COVID-19 presentation in ED, they would not be able to float back to the ward.

“If one or more nurses went into isolation, the department would have to draw staff out of a higher population area or reduce services.

“Compensating within the current roster is just not possible – even with overtime.”

Susan says the hospital has enough PPE, but staff are still waiting for fit testing to be provided.