Public Health
Town fights to keep nurses, doctors
A man’s death throws the spotlight on a rural hospital starved of resources.
‘No doctors at Tenterfield Hospital this weekend; HNEH says it will manage situation.’ – Tenterfield Star, Friday 25 October.
‘Patient dies while no doctor present at Tenterfield hospital.’ – Tenterfield Star, Tuesday 29 October.
The above headlines bracketed the death of a male patient who went into cardiac arrest at the hospital on Sunday 27 October.
The hospital, in the northern New England region, had no doctor from Tuesday to Monday because the usual medical officer was on leave and HNEH could not find a locum.
Only two nurses – an agency registered nurse and an enrolled nurse – were on shift when the man died. Paramedics were called in to work on him.
The hospital was “unable to provide sufficient clinical resources to manage the rapidly deteriorating patient” a spokesperson for Hunter New England Health told the Star.
The patient’s death followed months of community protest over HNEH’s decision to cut staffing to two nurses on day shift.
The cut was imposed shortly before a new emergency department opened and was done without any consultation or risk assessment for remaining staff.
The NSWNMA’s Assistant General Secretary Judith Kiejda voiced her concerns after the cut.
“The LHD has a duty of care to ensure the hospital is safely and appropriately staffed at all times. Unless a modest increase in nursing staff occurs quickly, nurses will be forced to work in isolation, with no capacity for relief or assistance if two nurses are required for a medical procedure,” Judith said in a media release.
Technology is not an adequate substitute
NSWNMA General Secretary Brett Holmes told the Star that two nurses had been on duty in an unfamiliar, new ED when the man died.
The nurses received telephone help from a Narrabri doctor and subsequent assistance from Armidale and Tamworth, but technology “can’t replace the physical presence of a medical officer or additional skilled nurses,” Brett said.
“We don’t know whether it would have changed the outcome, but it would have made it a much easier situation to manage with another pair of skilled hands.”
He said it had been “very tough” on staff – and was compounded by having to deal with a bus crash the next day in which almost 20 students and teachers were involved.
“It is no wonder our members are on edge and the community is on edge.”
He said paramedics “did a great job when they got there after being called from theirs homes” but the incident “demonstrated the reason you need three nurses on duty: trying to manage a critical incident with two nurses, particularly when it progresses to cardiac arrest, is extraordinarily difficult”.
“Even when you might have a doctor on the phone, you need more than two pairs of hands to undertake resuscitation.
“The fact that the district knew there was no doctor and did not or could not add additional nursing staff to give that extra support is very disappointing.”
Since the staff cut, the NSWNMA has been campaigning for three staff on each shift – or two plus an on-call nurse as a minimum – to manage the 18-bed ward and ED.
The hospital has been hit by a wave of retirements and resignations. Five registered nurses are reported to have resigned this year solely due to excessive workloads.
The hospital had only three permanent RNs – including one on long-term leave – and six permanent part-time ENs when The Lamp went to press.
Residents show support for nurses
In August, Tenterfield residents rallied at a local park in support of nurses.
The crowd heard reports of many missed meal breaks and difficulty even finding time for a toilet break, long waits in emergency while staff were busy elsewhere, nurses lifting heavy patients single-handedly, and returning home at the end of a shift exhausted and fraught.
Speakers said understaffing had ‘poisoned’ the work environment to the extent that potential recruits are turned off and agency staff don’t want to return to the hospital.
Following the rally, and intervention by the NSWNMA, management introduced a cross-over shift from 11 am to 7.30 pm, to cover meal breaks.
However, attempts to recruit staff to fill the crossover shift have so far been unsuccessful.
RN Kimberley Druitt said with only two nurses on shift, staff were often forced to work alone or leave the ward unattended – and the new ED is even more isolated from the wards than the old one.
“Even if we get staff for the crossover shift, that won’t solve the problem; we need an on-call,” Kimberley said.
In September, about 200 residents gave nurses a standing ovation at a community health forum on hospital staffing.
“It made us all cry – it was a lovely gesture,” said RN Stacey Butler.
She said paying an on-call allowance was an insignificant cost to support nurses with extra staffing in busy periods.
“We have warned for years that understaffing has to be fixed and we need to fight to make this hospital safe again.”
STOP PRESS
Meetings have been held with the NSW Health Minister and Hunter New England LHD Chief Executive, Michael DiRienzo, with neither giving any commitments to improve staffing, despite the tragic outcomes.
Deborah Reid says
My heart goes out to the 2 Nurses on duty that fateful day, when will they realize that money doesn’t save lives the appropriate amount of staff will, how much further are they going to cut staff in our rural hospitals where we have little backup as it is. How can 2 nurses tend to patient care on the wards as well as manage a emergency department.Staff attending a patient on there own if this patient requires 2 nurses how is this allowed if one of these nurses hurt there self who is to blame there I bet it would be the nurse not the fact they didn’t have enough staff to attend to the patients needs.I would think it is a humans right to have a meal and toilet break and I bet these nurses don’t get paid for there missed meal breaks.I can feel why so many nurses are exhausted and fraught and are leaving this profession.Its time the government look and listen to what we are asking for RATIOS for all hospitals.
Karen says
It’s no different at other local hospitals all around that region. This is not an isolated incident. virtually every hospital north of Armidale through to the boarder is run daily on minimal staffing similar to those experienced at Tenterfield . Every one of these hospitals not only has minimal nursing staff, daily, but are run by GP’s who are not in the hospital 24/7 and when they have days off or holidays the hospitals are left with no medical coverage at all. It’s time the area health service was held accountable for the lack of staff and the risk posed to staff and patients, in ALL of these hospitals. What happened at Tenterfield will, and has happened at other hospitals in the northern tablelands and will continue until the problem is addressed as a whole.
Kate says
Bonalbo MPS… government builds brand new hospital,, all the mod cons,,, Not enough trained staff and Doctor available 24/7.. Nurses under extreme pressure, caters for aged care as well….What a waste of ,money if there is NOT adequate staff.