The Northern NSW Local Health District agreed to talks with nurses at Ballina Hospital after they closed beds over a staffing shortage in a busy ED where only one nurse is rostered overnight.

Twelve years without an increase in staffing despite soaring demand has driven Ballina nurses to action in search of more help on night shift in the hospital’s emergency department.

The action involved closing beds for more than 24 hours and permanently taking away the department’s “treatment” chairs.

It prompted the LHD to sit down with nurses for an emergency meeting to discuss staffing.

“During the action the patients were either moved out of those beds or they sat in the waiting room,” said Suzie Melchior, the NSWNMA Ballina branch secretary.

“If it was an emergency, however, we didn’t withdraw care. We did provide care for a patient with low blood pressure and a patient who was septic. We did not compromise their safety.”

The LHD has promised to review patient statistics in the emergency department and how often the after hours nurse manager (AHNM) works clinically in the ED.

In the meantime the hospital has introduced an “escalation policy” that would see an additional nurse during high demand periods, although the Association is waiting to see this policy in writing.

Local population grows exponentially

Suzie Melchoir says members would like to see the hospital employ a dedicated triage nurse overnight with oversight of the 21 chairs in the waiting room area. And they would like to see staffing parity with other similar sized emergency departments in the Northern NSW LHD.

Murwillumbah District Hospital had 126 fewer presentations in the first three months of 2019 and yet it has two nurses on 10-hour night shifts and higher daytime staff levels.

“Ballina’s emergency unit hasn’t had a staffing review or additional staffing in 12 years, but around us the district shire is exponentially growing compared to 12 years ago, as is the use of the emergency department by the community,” says Suzie, a Clinical Nurse Specialist.

Ballina Hospital has over 17,000 emergency presentations every year.

Suzie says that in the 17 years she has worked at Ballina, she has seen emergency staff creating stopgap solutions to cope with the demand.

“The department has nine beds and is funded for nine treatment spaces. We actually created additional chair spaces that we were never funded for in an effort to meet KPIs such as length of stay, transfer of care time and time to treatment, but in doing that we created extra work for ourselves that we were never staffed for.

“I’m afraid that one of our nurses will have a career-ending injury or psychological injury, or a patient will have an adverse event because of the unsafe workloads,” says.

Band-aid solutions aren’t working

Currently, during the day, two nurses are rostered in emergency until 10 am and three nurses are rostered after 10 am, and a nurse is allocated to triage but is required to assist clinically within the unit. But Suzie says the biggest problem is the nightshift, where just one nurse is rostered.

“We don’t have a dedicated triage nurse on the night shift, so one nurse is doing the triage as well as the clinical and clerical work. We don’t have someone to look after people in the waiting room during the night shift. There are no clerical staff to answer phones because they finish at 9 pm.”

Suzie says the hospital has introduced “band aids” to offer relief to the night nurse, such as introducing an evening facility nurse. An after-hours nurse manager is also expected to assist the ED nurse, but this 
means leaving other areas in the hospital unattended.

While a doctor is also rostered on overnight, Suzie says the doctor is often called to another part of the hospital to attend clinical reviews and the nurse is working in isolation.”

Suzie told The Lamp: “I don’t think we meet standards for triage according to the Australasian College of Emergency Medicine guidelines. We don’t have a dedicated triage nurse each shift and the ED NUM is not a full-time manager but clinical for three days of the week. There is just one after-hours manager for the 
whole hospital.”

Suzie says the area’s ambulance service is also short-staffed, which means the emergency department’s workloads increase as patients wait for transfers.

“We have these really drawn out lengths of stay while patients wait to be transferred to the appropriate hospital, and often that means patients staying in the emergency department overnight.”

“We are drawing a line in the sand. We have identified the problem and we are asking for a solution, but we are yet to hear an official word. This is about patient safety and for improved services for the community of Ballina.”