Understaffed rural hospitals brace for COVID-19
COVID-19 is yet to infect the twin townships of Harden and Murrumburrah, but the local hospital already struggles to find enough nurses.
Nurses at Murrumburrah-Harden District Hospital, about 350 km south-west of Sydney, are in “a heightened state of preparedness” for any COVID-19 outbreak, says RN and clinical nurse educator Marilyn Wales.
“We conduct ‘desktop’ scenarios all the time,” Marilyn says. “What do you do if you get a potentially positive presentation, or a staff member develops symptoms? What do you do if you see a breach of PPE?”
“The reality is that COVID-19 is going to come out to small country hospitals like ours. Essential workers pass through our town all the time and stop for meals and fuel.”
An “essential worker” who visited Harden-Murrumburrah, population 2000, later produced a positive result but there was no local transmission.
Marilyn is secretary and delegate for the NSWNMA’s Harden branch. She shares ideas with NSWNMA members at hospitals across the state through fortnightly webinars and other teleconferencing.
“Every facility talks about staff shortages and inadequate skill mix and how hard it is to attract staff – especially experienced nurses – to small rural hospitals.
“Murrumburrah-Harden’s casual pool is very limited, and we often have difficulty engaging agency staff, partly because of COVID-19 restrictions.
“The nursing population is ageing and we are losing senior nurses who are FLECC (first line emergency care course) trained. That training gives us the ability to use the rural adult emergency care guidelines and administer certain drugs in the absence of a doctor.
“Senior nurses who leave are often replaced by RNs who have just completed their graduate year. They are put in charge of a hospital on weekends and nights with no doctor. That is just asking for trouble.”
Murrumburrah-Harden Hospital has nine acute beds and 20 residential aged care beds. It has a VMO on call.
Like many small sites, the RN in charge of the acute ward is also in charge of ED.
“If we had a respiratory presentation and had to isolate that person, it would take a staff member away for the entirety of that presentation,” Marilyn says.
“We don’t have the staff rostered on to manage that.
“If we get a COVID-19 case, one or more staff members may have to isolate for the required 14 days. If we take out two or three staff, we could be at service failure, because we don’t have the clinical staff resources to replace them.
“My heart broke when I heard that the department was thinking of fast-tracking students into hospitals. It’s an awful atmosphere to ask someone to start their career – in a pandemic.
“Students are already at risk of not being able to register with AHPRA (Australian Health Practitioner Regulation Agency) due to incomplete placements.
“Another government proposal was to bring back retired nurses. People retire for a reason and to bring them back and put their physical and mental health at risk is a big ask.
“Our Premier keeps saying our health system is coping. But staff are having to work 12- or 16-hour shifts and work on their RDOs.
“We might be coping at the moment, but we are not functioning in the proper manner, to the best of our abilities. For us to function we need to have enough staff with the required skills.”
Marilyn, who has nursed in Temora, Narrandera and Murrumburrah-Harden hospitals for 51 years, says she’s concerned for all nurses at this time.
“I’m especially concerned for the girls in Sydney. I cannot comprehend what some of them are going through.”