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.”
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.