An exodus of nurses from Tweed Hospital in the far north of NSW tells a tale of two health systems.

 Tweed Hospital lost 18 nurses from its Emergency Department (ED) between December 2021 and mid-January 2022. Many of these nurses were the hospital’s most experienced ED nurse clinicians.

Most of those 18 left to take jobs at Gold Coast University Hospital and other Queensland health facilities within a 45-minute drive from Tweed Heads, which is one kilometre from the state border.

Their departure comes as no surprise to senior nurse Kristin Ryan-Agnew, president of the Tweed Hospital branch of the NSWNMA.

“In Queensland, a Labor govern-ment gives nurses guaranteed staffing ratios, COVID bonuses, an $1800-a-year education allowance with dedicated fixed times for education, and maximum salary sacrificing,” Kristin says.

“Here in New South Wales, we get none of that. We are bleeding staff who are burnt out and looking for better employment.”

Tweed is a Level 5 referral hospital serving a hinterland that includes the major tourist destination of Byron Bay.

It has the busiest ED outside of Greater Sydney/Newcastle, with the same UDG level of presentations as St Vincent’s in the heart of Sydney.

However, long-term understaffing and over-reliance on junior nurses has been made worse by pandemic-related staff shortages.

“People are doing double shifts every day with just one day off after night duties,” Kristin says.

“This week we are supposed to have 18 nurses per shift, but we only have 10 nurses to staff morning and afternoon shift. The junior nurses are out of their depth and freaking out completely.”

Increasingly reliant on junior nurses

Tweed ED is increasingly reliant on junior nurses, yet has just one nurse educator for an FTE (full time-equivalent) staff of 150.

“We have been pleading for three years to get a second nurse educator in ED, because most of the new staff appointments have been second- and third-years with no emergency experience.”

Many of Tweed’s junior nurses unsuccessfully applied for graduate positions, which are in short supply.

“As a graduate you come into a designated position in the hospital for 12 months and you are supported by a clinical nurse educator (CNE) for the year.

“Those who missed out on graduate positions have been working in nursing homes or on the wards, but very few have acute experience.

“A lot of them are straight out of uni and did at least part of their study remotely during COVID – so how much practical experience did they get?

“If management is going to put junior people out there, it has to have someone there to show them how to do the job and back them up.

“But management won’t give juniors the support they need.”

Staff shortages pre-date COVID

Kristin says inadequate staffing and unsustainable workloads pre-date COVID.

“We have been raising these issues for years and COVID has pushed the situation over the edge.

“Our hospital executive says they have escalated our request for a second CNE to Northern NSW LHD executive and their response was ‘no’.

“The Tweed branch (of the NSWNMA) prides itself on its philosophy of working with the hospital executive for the best possible outcomes for the nursing staff.

“If both parties are committed to a common goal, the relationship needs to be bipartisan. It just won’t work if we are working with one hand tied behind our back.”

Kristin says local National Party MP Geoff Provest has never actively supported nurses and midwives.

“We have appealed for his support previously. Our branch executive has sat with him in his office to explain how dire the situation is – all to no avail.”

She says NSW has gone from “one of the best paid nursing and midwifery services in the country to the worst.”

As an example, she cites the Queensland Health Service policy of allowing nurses and midwives to salary sacrifice to the full extent permitted under the tax system.

“We have never received a single pay rise above CPI, but the NSW Government has continued to take 50 per cent of nurses’ and midwives’ potential salary sacrificing and put it into government coffers.”

Kristin says the rapid escalation of COVID has seen a severe deterioration of working conditions for all nursing staff.

This is compounded in regional areas by delayed transportation of critical equipment, resulting, for example, in shortages of some PPE.

“Some nurses and midwives can’t access the masks they were fitted for because the trucks are not delivering. These nurses and midwives are worried – some have got children at home and the masks they now have to wear are not safe.”